Individual
MARISSA FAITH WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
13695 US HIGHWAY 1, SEBASTIAN, FL 32958-3230
(772) 589-3196
(321) 843-2196
Mailing address
13695 US HIGHWAY 1, SEBASTIAN, FL 32958-3230
(772) 589-3196
(321) 843-2196
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
883594
TX
367500000X
Certified Registered Nurse Anesthetist
120273
AR
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN11014736
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117204000
—
FL
Enumeration date
04/08/2019
Last updated
04/02/2025
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