Provider Demographics
NPI:1053859454
Name:WALDO, AUDREYLYN (ARNP)
Entity Type:Individual
Prefix:
First Name:AUDREYLYN
Middle Name:
Last Name:WALDO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 NW LAKE WHITNEY PL
Mailing Address - Street 2:STE 101
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1618
Mailing Address - Country:US
Mailing Address - Phone:772-344-7228
Mailing Address - Fax:
Practice Address - Street 1:1713 HWY 441 NORTH
Practice Address - Street 2:SUITE C
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972
Practice Address - Country:US
Practice Address - Phone:863-467-2159
Practice Address - Fax:863-763-0681
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9320988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily