Provider Demographics
NPI:1700444536
Name:BALTODANO, WAYVA LYANN JANE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:WAYVA
Middle Name:LYANN JANE
Last Name:BALTODANO
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5031 SW 40TH LN
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-9580
Mailing Address - Country:US
Mailing Address - Phone:352-875-0792
Mailing Address - Fax:
Practice Address - Street 1:2845 SE 3RD CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0444
Practice Address - Country:US
Practice Address - Phone:352-369-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002598363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily