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General NPI Number Information
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NPI Number | 1245263086
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Entity Type | Individual
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Provider Name | JOAN M WYATT MD
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Gender | Female
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3740 INTERNATIONAL GOLF PKWY
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-0665
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Country | US
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Telephone | 904-671-8333
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Fax |
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Provider Business Mailing Address
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Address Line | 3740 INTERNATIONAL GOLF PKWY
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-0665
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Country | US
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Telephone | 904-671-8333
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A052615
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 235566-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 44702
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9268
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License Number State | SD
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 132924
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License Number State | FL
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