Provider Demographics
NPI:1063922656
Name:WENDT, RONALD MICHAEL (ARNP, FNP-BC)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:MICHAEL
Last Name:WENDT
Suffix:
Gender:M
Credentials:ARNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3703 CRILL AVE
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-9168
Mailing Address - Country:US
Mailing Address - Phone:386-866-9100
Mailing Address - Fax:386-866-1900
Practice Address - Street 1:3703 CRILL AVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177
Practice Address - Country:US
Practice Address - Phone:386-866-9100
Practice Address - Fax:386-866-1900
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9295443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty