Provider Demographics
NPI:1013007723
Name:WOLFE, WANEDA KAY (MN, CNS, ANP)
Entity Type:Individual
Prefix:MS
First Name:WANEDA
Middle Name:KAY
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MN, CNS, ANP
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:PO BOX 913
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32402-0913
Mailing Address - Country:US
Mailing Address - Phone:850-814-8400
Mailing Address - Fax:850-215-8405
Practice Address - Street 1:100 DOCTORS DR STE C
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7609
Practice Address - Country:US
Practice Address - Phone:850-814-8400
Practice Address - Fax:850-215-8405
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP3417872363LA2200X, 364SP0812X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SP0812XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Community