Provider Demographics
NPI:1235988742
Name:WIZZARD, VELMA
Entity type:Individual
Prefix:
First Name:VELMA
Middle Name:
Last Name:WIZZARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4034 SW HAYCROFT ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-7203
Mailing Address - Country:US
Mailing Address - Phone:772-418-7603
Mailing Address - Fax:
Practice Address - Street 1:4034 SW HAYCROFT ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-7203
Practice Address - Country:US
Practice Address - Phone:772-418-7603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL239827253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care