Provider Demographics
NPI:1467790360
Name:OTTATI, WENDY SUSAN (ARNP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:SUSAN
Last Name:OTTATI
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 1:670 N ORLANDO AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4465
Mailing Address - Country:US
Mailing Address - Phone:407-644-8193
Mailing Address - Fax:407-644-8198
Practice Address - Street 1:670 N ORLANDO AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4465
Practice Address - Country:US
Practice Address - Phone:407-644-8193
Practice Address - Fax:407-644-8198
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2970282363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner