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General NPI Number Information
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NPI Number | 1700444536
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Entity Type | Individual
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Provider Name | WAYVA LYANN JANE BALTODANO APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/05/2019
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 2845 SE 3RD CT
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City | OCALA
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State | FL
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Zip | 34471-0444
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Country | US
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Telephone | 352-369-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 5031 SW 40TH LN
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City | OCALA
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State | FL
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Zip | 34474-9580
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Country | US
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Telephone | 352-875-0792
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11002598
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License Number State | FL
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