Provider Demographics
NPI:1710964093
Name:WASZAK, LOUISE C (PHD, ARNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:C
Last Name:WASZAK
Suffix:
Gender:F
Credentials:PHD, ARNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 TURKEY CREEK
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615
Mailing Address - Country:US
Mailing Address - Phone:386-462-9907
Mailing Address - Fax:
Practice Address - Street 1:4520 W US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-8341
Practice Address - Country:US
Practice Address - Phone:386-719-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP 009371363LF0000X
WAAP30008047363LF0000X, 364SM0705X
FLARNP 9322769363LF0000X
PASP002220D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
230417OtherL&I
WA9655978Medicaid
WAG8871962OtherNEW MEDICARE SNO. CO
8946801OtherCRIME VICTIMS
WAG8871961OtherNEW MEDICARE KING CO
MD0211088-06OtherANCC PNP CERT
MD2006009683OtherANCC FNP CERT
MD20060018OtherPNCB AC-PNP CERT
MD20060018OtherPNCB AC-PNP CERT