Healthcare Provider Details

I. General information

NPI: 1235713124
Provider Name (Legal Business Name): WENDY SHERI LUNDBLAD FAMILY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27455 CASHFORD CIR
WESLEY CHAPEL FL
33544-6901
US

IV. Provider business mailing address

PO BOX 1431
ZEPHYRHILLS FL
33539-1431
US

V. Phone/Fax

Practice location:
  • Phone: 813-906-6554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11012689
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: