Provider Demographics
NPI:1780926378
Name:DEMKO, WENDY B (NP-C)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:B
Last Name:DEMKO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:R
Other - Last Name:BLAGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 361095
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32936-1095
Mailing Address - Country:US
Mailing Address - Phone:321-241-4877
Mailing Address - Fax:321-241-4879
Practice Address - Street 1:8057 SPYGLASS HILL RD STE 104
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8565
Practice Address - Country:US
Practice Address - Phone:321-241-4877
Practice Address - Fax:321-241-4879
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170539363LA2200X
FLAPRN11001845363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health