Provider Demographics
NPI:1225794266
Name:DENSON, WAYNE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:
Last Name:DENSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:WAYNE
Other - Middle Name:
Other - Last Name:DENSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:5921 NW 44TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-8211
Mailing Address - Country:US
Mailing Address - Phone:352-219-6125
Mailing Address - Fax:
Practice Address - Street 1:2000 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1136
Practice Address - Country:US
Practice Address - Phone:352-273-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115215363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical