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General NPI Number Information
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NPI Number | 1992886915
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Entity Type | Individual
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Provider Name | JOHN GERRITY WADE ACNP
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 09/08/2008
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Provider Practice Location Address
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Address Line | 309 NW 5TH STREET
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City | OKEECHOBEE
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State | FL
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Zip | 34972
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Country | US
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Telephone | 863-467-1428
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Fax | 863-467-8133
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Provider Business Mailing Address
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Address Line | 549 NW LAKE WHITNEY PLACE SUITE 106
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City | PORT ST LUCIE
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State | FL
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Zip | 34986
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Country | US
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Telephone | 772-621-9993
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Fax | 772-621-9923
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | ARNP3222832
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License Number State | FL
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