Spacecoast Wound Specialist LLC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

Legal business name

SPACECOAST WOUND SPECIALIST LLC

Practice address

770 Schuster Rd SW
Palm Bay, FL 32908-1711

Phone

(321) 720-3014

NPI assigned

Aug 5, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marianne Arruda-WennbergNPI 1245965458

Title

Owner

Phone

(321) 720-3014

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marianne Arruda-Wennberg, APRN

  • Gerontology Nurse Practitioner
  • Palm Bay, FL
  • NPI 1245965458
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725494400000",
    "number": "1417787490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 SCHUSTER RD SW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329081711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 SCHUSTER RD SW",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329081711",
            "telephone_number": "321-720-3014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACECOAST WOUND SPECIALIST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-05",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A",
        "authorized_official_last_name": "ARRUDA-WENNBERG",
        "authorized_official_first_name": "MARIANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-720-3014"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Katie Sprosty

• Gerontology Nurse Practitioner in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• Gerontology Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.