Healthcare Provider Details

I. General information

NPI: 1164809257
Provider Name (Legal Business Name): WILEDADE AUGUSTIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 PGA BLVD
PALM BEACH GARDENS FL
33410-2823
US

IV. Provider business mailing address

3401 PGA BLVD
PALM BEACH GARDENS FL
33410-2823
US

V. Phone/Fax

Practice location:
  • Phone: 561-219-1000
  • Fax: 689-304-0303
Mailing address:
  • Phone: 561-219-1000
  • Fax: 689-304-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9290112
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: