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General NPI Number Information
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NPI Number | 1093896540
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Entity Type | Individual
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Provider Name | AMY MARIE WYBENGA CRNP
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Gender | Female
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 15415 PANAMA CITY BEACH PKWY
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32413-5409
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Country | US
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Telephone | 850-588-3589
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Fax | 850-588-3593
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Provider Business Mailing Address
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Address Line | 89 SUWANNEE DR
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City | INLET BEACH
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State | FL
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Zip | 32461-8689
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Country | US
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Telephone | 334-233-1815
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Fax | 850-588-3593
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11024394
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License Number State | FL
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