Individual
WYNIQUA STUDIVANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
201 N PARK AVE, APOPKA, FL 32703-4147
(407) 889-1953
Mailing address
201 N PARK AVE, APOPKA, FL 32703-4147
(407) 889-1953
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
APRN11011179
FL
363LG0600X
Gerontology Nurse Practitioner
SP019871
PA
363LP2300X
Primary Care Nurse Practitioner
SP019871
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110826800
—
FL
Enumeration date
03/06/2019
Last updated
03/03/2025
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