Provider Demographics
NPI:1699367011
Name:WAYMAKER NP CARE LLC
Entity Type:Organization
Organization Name:WAYMAKER NP CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MOODIE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:386-882-0063
Mailing Address - Street 1:921 REDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-4571
Mailing Address - Country:US
Mailing Address - Phone:386-882-0063
Mailing Address - Fax:
Practice Address - Street 1:1700 RIDGEWOOD AVE STE H
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-1782
Practice Address - Country:US
Practice Address - Phone:386-882-0063
Practice Address - Fax:386-281-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care