Provider Demographics
NPI:1093425415
Name:WIENK, DARIS
Entity Type:Individual
Prefix:
First Name:DARIS
Middle Name:
Last Name:WIENK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15210 AMBERLY DR APT 1628
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2193
Mailing Address - Country:US
Mailing Address - Phone:239-682-6835
Mailing Address - Fax:
Practice Address - Street 1:15210 AMBERLY DR APT 1628
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2193
Practice Address - Country:US
Practice Address - Phone:239-682-6835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer