Individual
ALLISON R. WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2 TAMPA GENERAL CIR, TAMPA, FL 33606-3571
(813) 821-8038
(813) 974-4325
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 821-8038
(813) 974-4325
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN11015787
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113245600
—
FL
01
—
LW8BG
BLUE CROSS BLUE SHIELD
FL
Enumeration date
01/20/2022
Last updated
03/03/2022
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