Individual
JUSTIN D WASDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10080 SW INNOVATION WAY STE 102, PORT ST LUCIE, FL 34987-2129
(772) 344-3811
(772) 283-4919
Mailing address
PO BOX 417, STUART, FL 34995-0417
(772) 223-2832
(772) 223-5646
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9110163
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019931500
—
FL
01
—
J2ZXG
FLORIDA BLUE
FL
Enumeration date
01/19/2017
Last updated
10/14/2020
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