=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285443960
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDY L ROUSE DNP, RN, CCM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2025
-----------------------------------------------------
Last Update Date | 01/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3511 NE 183RD LN
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32609-4361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-272-0915
-----------------------------------------------------
Fax | 352-289-8291
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3511 NE 183RD LN
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32609-4361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-272-0915
-----------------------------------------------------
Fax | 352-289-8291
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number | 00056540
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174H00000X
-----------------------------------------------------
Taxonomy Name | Health Educator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 00056540
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 364SC1501X
-----------------------------------------------------
Taxonomy Name | Community Health/Public Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | RN2735832
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN2735832
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------