Individual
MARY G WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
5950 S FLORIDA AVE, LAKELAND, FL 33813-2532
(407) 438-3557
(407) 438-3558
Mailing address
5950 S FLORIDA AVE, LAKELAND, FL 33813-2532
(407) 438-3557
(407) 438-3558
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
ARNP9232495
FL
Other
Enumeration date
04/10/2011
Last updated
05/29/2015
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