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General NPI Number Information
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NPI Number | 1013458561
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Entity Type | Individual
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Provider Name | WENDY PHREUD EDMOND AC-AGNP
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Gender | Male
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Dates
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Enumeration Date | 03/16/2017
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 9299 SW 152ND ST STE 203
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City | PALMETTO BAY
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State | FL
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Zip | 33157-1776
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Country | US
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Telephone | 305-322-4166
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Fax |
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Provider Business Mailing Address
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Address Line | 3178 STIRLING RD UNIT J7
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City | HOLLYWOOD
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State | FL
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Zip | 33021-2058
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Country | US
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Telephone | 786-290-3485
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 64577
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 73900
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 71013924A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APRN9336037
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License Number State | FL
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