Provider Demographics
NPI:1417563891
Name:WAWRYSZYN, BARBARA KATARZYNA (APRN)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:KATARZYNA
Last Name:WAWRYSZYN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9235
Mailing Address - Fax:393-434-0082
Practice Address - Street 1:12600 CREEKSIDE LN STE 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3353
Practice Address - Country:US
Practice Address - Phone:239-343-9235
Practice Address - Fax:239-343-4008
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012941363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120769900Medicaid