Provider Demographics
NPI:1609469394
Name:WILDER, STEPHANIE B (APRN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:B
Last Name:WILDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:B
Other - Last Name:ROEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 N CATTLEMEN RD STE 220
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6422
Mailing Address - Country:US
Mailing Address - Phone:941-371-6565
Mailing Address - Fax:941-377-7731
Practice Address - Street 1:600 N CATTLEMEN RD STE 220
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6422
Practice Address - Country:US
Practice Address - Phone:941-371-6565
Practice Address - Fax:941-377-7731
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011573363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11011573OtherSTATE LICENSE