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General NPI Number Information
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NPI Number | 1881476414
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Entity Type | Individual
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Provider Name | ERIN WALENCZYK FNP
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Gender | Female
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Dates
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Enumeration Date | 10/18/2023
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Last Update Date | 02/22/2025
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Provider Practice Location Address
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Address Line | 183 LANDRUM LN STE 104
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-3838
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Country | US
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Telephone | 904-267-0146
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Fax |
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Provider Business Mailing Address
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Address Line | 312 TWILIGHT LN
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32095-0082
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Country | US
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Telephone | 732-804-8637
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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 | 26NJ14931600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11028577
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License Number State | FL
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