MEDICARE: WENDY MICHELLE WEISHEIMER APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	11001239	FL

General Provider Information

NPI Number	:	1821555947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY MICHELLE WEISHEIMER APRN

Provider Business Mailing Address
First Line	:	6659 ENGRAM RD
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32169-4917
Country	:	US
Telephone Number	:	386-402-2279
Fax Number	:

Provider Business Practice Location Address
First Line	:	6659 ENGRAM RD
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32169-4917
Country	:	US
Telephone Number	:	386-402-2279
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2019
Last Update Date	:	02/25/2019

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