Provider Demographics
NPI:1427880830
Name:WOJDYGA, MICHAL TOMASZ
Entity type:Individual
Prefix:
First Name:MICHAL
Middle Name:TOMASZ
Last Name:WOJDYGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6318 HAVENSPORT DR
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-1774
Mailing Address - Country:US
Mailing Address - Phone:561-859-3665
Mailing Address - Fax:
Practice Address - Street 1:6043 WINTHROP COMMERCE AVE STE 201
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-4274
Practice Address - Country:US
Practice Address - Phone:813-291-0629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11030643363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty