Provider Demographics
NPI:1306843982
Name:WADHWA, MUKESH (ARNP)
Entity Type:Individual
Prefix:
First Name:MUKESH
Middle Name:
Last Name:WADHWA
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5796 N PLUMBAY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321
Mailing Address - Country:US
Mailing Address - Phone:954-722-7976
Mailing Address - Fax:954-722-8891
Practice Address - Street 1:3000 N UNIVERSITY DR
Practice Address - Street 2:STE R
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5082
Practice Address - Country:US
Practice Address - Phone:954-753-0300
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9165576 ARNP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily