Provider Demographics
NPI:1760609960
Name:WADSWORTH, PATRICE WOO (ARNP)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:WOO
Last Name:WADSWORTH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 8TH TER
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-2836
Mailing Address - Country:US
Mailing Address - Phone:772-770-2311
Mailing Address - Fax:
Practice Address - Street 1:960 37TH PL
Practice Address - Street 2:SUITE 105
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6586
Practice Address - Country:US
Practice Address - Phone:772-299-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9204512363L00000X
FL2007001598363LF0000X
FLARNP9204512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner