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General NPI Number Information
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NPI Number | 1639461023
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Entity Type | Individual
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Provider Name | NYDIA M WHITAKER ARNP
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Gender | Female
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 12/25/2024
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Provider Practice Location Address
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Address Line | 800 VIRGINIA AVE STE 59B
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City | FORT PIERCE
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State | FL
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Zip | 34982-5892
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Country | US
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Telephone | 772-577-6323
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Fax |
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Provider Business Mailing Address
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Address Line | 770 SW AVENS ST
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-8757
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Country | US
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Telephone | 772-380-3144
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Fax | 877-733-7082
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | 000174302
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 000174301
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 000174300
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11029135
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License Number State | FL
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