Individual
DR. NANCY MARIE WENK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
317 RIVEREDGE BLVD, SUITE 104, COCOA, FL 32922-7988
(321) 264-1105
Mailing address
3461 OWLS WOOD WAY, TITUSVILLE, FL 32780-2541
(321) 264-0383
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY 4765
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
73996
BLUE CROSS BLUE SHIELD
FL
Enumeration date
01/02/2007
Last updated
07/08/2007
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