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General NPI Number Information
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NPI Number | 1851818645
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Entity Type | Individual
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Provider Name | WANDA JEAN WINARSKI NP-C
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Gender | Female
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 08/23/2017
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Provider Practice Location Address
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Address Line | 5220 BELFORT RD STE 130
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6018
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Country | US
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Telephone | 904-446-3760
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Fax |
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Provider Business Mailing Address
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Address Line | 105 EVERGREEN CT
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City | COLLINSVILLE
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State | IL
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Zip | 62234-4781
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Country | US
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Telephone |
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 2017005252
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2017005252
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License Number State | MO
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