Healthcare Provider Details

I. General information

NPI: 1609469394
Provider Name (Legal Business Name): STEPHANIE B WILDER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE B ROEDER

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N CATTLEMEN RD STE 220
SARASOTA FL
34232-6422
US

IV. Provider business mailing address

600 N CATTLEMEN RD STE 220
SARASOTA FL
34232-6422
US

V. Phone/Fax

Practice location:
  • Phone: 941-371-6565
  • Fax: 941-377-7731
Mailing address:
  • Phone: 941-371-6565
  • Fax: 941-377-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11011573
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: