Healthcare Provider Details

I. General information

NPI: 1013843952
Provider Name (Legal Business Name): PREMIER PSYCHIATRY OF WELLINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11592 E RAMBLING DR
WELLINGTON FL
33414-5016
US

IV. Provider business mailing address

11592 E RAMBLING DR
WELLINGTON FL
33414-5016
US

V. Phone/Fax

Practice location:
  • Phone: 561-888-2492
  • Fax:
Mailing address:
  • Phone: 561-888-2492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AYLIN WOLTER
Title or Position: PROVIDER
Credential: NURSE PRACTITIONER
Phone: 561-888-2492