Provider Demographics
NPI:1285006205
Name:MORTON, WENDY ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ANN
Last Name:MORTON
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 1:945 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3905
Mailing Address - Country:US
Mailing Address - Phone:386-801-2795
Mailing Address - Fax:
Practice Address - Street 1:1688 W GRANADA BLVD
Practice Address - Street 2:STE 2A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-1851
Practice Address - Country:US
Practice Address - Phone:386-425-4460
Practice Address - Fax:386-425-4461
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9335586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily