Provider Demographics
NPI:1598100893
Name:WISNEWSKI, SERINA (APRN)
Entity Type:Individual
Prefix:
First Name:SERINA
Middle Name:
Last Name:WISNEWSKI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 FLORIDA AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2436
Mailing Address - Country:US
Mailing Address - Phone:321-690-0002
Mailing Address - Fax:321-632-1358
Practice Address - Street 1:1273 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2436
Practice Address - Country:US
Practice Address - Phone:321-690-0002
Practice Address - Fax:321-632-1358
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9246684363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health