Provider Demographics
NPI:1477861623
Name:RADFORD, WANDA L (NP)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:L
Last Name:RADFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 N E ST
Mailing Address - Street 2:STE 331
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-6335
Mailing Address - Country:US
Mailing Address - Phone:850-484-6500
Mailing Address - Fax:850-857-1747
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:STE 331
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6335
Practice Address - Country:US
Practice Address - Phone:850-484-6500
Practice Address - Fax:850-857-1747
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2609562363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner