Healthcare Provider Details

I. General information

NPI: 1215203047
Provider Name (Legal Business Name): VANDY NICHOLE MAYWORTH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4240 SUN N LAKE BLVD STE 200
SEBRING FL
33872-1944
US

IV. Provider business mailing address

4240 SUN N LAKE BLVD STE 200
SEBRING FL
33872-1944
US

V. Phone/Fax

Practice location:
  • Phone: 863-402-2229
  • Fax: 863-402-1209
Mailing address:
  • Phone: 863-402-2229
  • Fax: 863-402-1209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP9270201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: