Provider Demographics
NPI:1093896540
Name:WYBENGA, AMY MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:WYBENGA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 SUWANNEE DR
Mailing Address - Street 2:
Mailing Address - City:INLET BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32461-8689
Mailing Address - Country:US
Mailing Address - Phone:334-233-1815
Mailing Address - Fax:850-588-3593
Practice Address - Street 1:15415 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-5409
Practice Address - Country:US
Practice Address - Phone:850-588-3589
Practice Address - Fax:850-588-3593
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024394363LF0000X
AL1-061747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51533030OtherBLUE CROSS