Provider Demographics
NPI:1336218791
Name:STRUK, IDELLA ANNE (ARNP-C)
Entity Type:Individual
Prefix:MRS
First Name:IDELLA
Middle Name:ANNE
Last Name:STRUK
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:IDELLA
Other - Middle Name:ANNE
Other - Last Name:WESSELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 CENTERVILLE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4675
Mailing Address - Country:US
Mailing Address - Phone:850-878-8121
Mailing Address - Fax:850-942-6515
Practice Address - Street 1:1401 CENTERVILLE ROAD
Practice Address - Street 2:SUITE 600
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-878-8121
Practice Address - Fax:850-942-6515
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2712462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8759OtherBCBS
FL300847900Medicaid
FLY8759OtherBCBS