Provider Demographics
NPI:1598009748
Name:WIELANDT, ERNESTINE
Entity Type:Individual
Prefix:
First Name:ERNESTINE
Middle Name:
Last Name:WIELANDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERNESTINE
Other - Middle Name:
Other - Last Name:WIELANDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:9081 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4915
Mailing Address - Country:US
Mailing Address - Phone:954-472-2972
Mailing Address - Fax:
Practice Address - Street 1:9081 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4915
Practice Address - Country:US
Practice Address - Phone:954-472-2972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-11
Last Update Date:2012-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2803292363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health