Provider Demographics
NPI:1841083581
Name:GROOMS, WONDRA C
Entity type:Individual
Prefix:
First Name:WONDRA
Middle Name:C
Last Name:GROOMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1464 VILLENA AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5048
Mailing Address - Country:US
Mailing Address - Phone:656-224-3309
Mailing Address - Fax:
Practice Address - Street 1:1464 VILLENA AVE APT 104
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5048
Practice Address - Country:US
Practice Address - Phone:656-224-3309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health