Provider Demographics
NPI:1871792713
Name:WAGNER, NANCY ANNE (ARNP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ANNE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MICCOSUKEE RD
Mailing Address - Street 2:HOSPITALIST GROUP
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5054
Mailing Address - Country:US
Mailing Address - Phone:850-431-4997
Mailing Address - Fax:850-431-6315
Practice Address - Street 1:1300 MICCOSUKEE ROAD
Practice Address - Street 2:HOSPITALIST GROUP
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4646
Practice Address - Country:US
Practice Address - Phone:850-431-4997
Practice Address - Fax:850-431-6315
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3172262363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY00RNOtherBCBS
FLAE724ZMedicare Oscar/Certification