Provider Demographics
NPI:1184605487
Name:WETHERINGTON, JUDITH J (CRNA)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:J
Last Name:WETHERINGTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 413012
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34101-3012
Mailing Address - Country:US
Mailing Address - Phone:239-261-1158
Mailing Address - Fax:239-261-4232
Practice Address - Street 1:4949 TAMIAMI TRAIL N
Practice Address - Street 2:STE 206
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103
Practice Address - Country:US
Practice Address - Phone:239-261-1158
Practice Address - Fax:239-261-4232
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1341682367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
G1317OtherBC BS
G1317UMedicare ID - Type Unspecified