Provider Demographics
NPI:1285443960
Name:ROUSE, WENDY L (DNP, RN, CCM)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:ROUSE
Suffix:
Gender:F
Credentials:DNP, RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 NE 183RD LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-4361
Mailing Address - Country:US
Mailing Address - Phone:727-272-0915
Mailing Address - Fax:352-289-8291
Practice Address - Street 1:3511 NE 183RD LN
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-4361
Practice Address - Country:US
Practice Address - Phone:727-272-0915
Practice Address - Fax:352-289-8291
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00056540171M00000X, 251B00000X
174H00000X
FLRN2735832364SC1501X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator
No251B00000XAgenciesCase Management
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health