Provider Demographics
NPI:1275520215
Name:WAYWOOD, NANCY A (CRNA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:WAYWOOD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:A
Other - Last Name:ORLOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:5033 LA COSTA ISLAND CT
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-8528
Mailing Address - Country:US
Mailing Address - Phone:610-585-5952
Mailing Address - Fax:
Practice Address - Street 1:2500 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5000
Practice Address - Country:US
Practice Address - Phone:941-766-4122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN283273L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS87935Medicare UPIN