Healthcare Provider Details

I. General information

NPI: 1730580010
Provider Name (Legal Business Name): WENDY E SWAYNE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6085 OLD NATIONAL HWY STE G
ATLANTA GA
30349-4333
US

IV. Provider business mailing address

4700 MILLENIA BLVD STE 650
ORLANDO FL
32839-6013
US

V. Phone/Fax

Practice location:
  • Phone: 470-754-6360
  • Fax: 877-780-7359
Mailing address:
  • Phone: 407-533-6837
  • Fax: 407-770-0661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN236082
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: