Provider Demographics
NPI:1518188127
Name:HUCKERY, WENDY (ARNP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:HUCKERY
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 1:2151 MALACHITE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-8241
Mailing Address - Country:US
Mailing Address - Phone:863-397-5908
Mailing Address - Fax:
Practice Address - Street 1:9009 CORPORATE LAKE DR STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634
Practice Address - Country:US
Practice Address - Phone:863-667-8100
Practice Address - Fax:855-314-6843
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2159602363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP2159602OtherLICENSE