Provider Demographics
NPI:1295383743
Name:DELGADO, WAYNETTE
Entity Type:Individual
Prefix:
First Name:WAYNETTE
Middle Name:
Last Name:DELGADO
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 1:26052 OLD SPRING LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-8076
Mailing Address - Country:US
Mailing Address - Phone:352-799-6096
Mailing Address - Fax:
Practice Address - Street 1:26052 OLD SPRING LAKE RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-8076
Practice Address - Country:US
Practice Address - Phone:352-799-6096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider