Provider Demographics
NPI:1992886915
Name:WADE, JOHN GERRITY (ACNP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GERRITY
Last Name:WADE
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
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Mailing Address - Street 1:549 NW LAKE WHITNEY PLACE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986
Mailing Address - Country:US
Mailing Address - Phone:772-621-9993
Mailing Address - Fax:772-621-9923
Practice Address - Street 1:309 NW 5TH STREET
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972
Practice Address - Country:US
Practice Address - Phone:863-467-1428
Practice Address - Fax:863-467-8133
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP3222832363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care