Phyllis A. Wagner, ARNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

ARNP 670502 Issued in FL

Practice address

3390 SW 131St Ter
Davie, FL 33330-4618

Phone

(954) 424-0346

Fax

(954) 370-4833

NPI assigned

Sep 6, 2011

Last updated

Sep 6, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Wagner Group, Inc.

  dba Companion Call Light of South Florida

  • Emergency Response System Companies
  • Davie, FL
  • NPI 1134437767
  NPD (past)

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

{
    "created_epoch": "1315267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315267200000",
    "number": "1609157569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3390 SW 131ST TER",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333304618",
            "telephone_number": "954-424-0346",
            "fax_number": "954-370-4833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3390 SW 131ST TER",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333304618",
            "telephone_number": "954-424-0346",
            "fax_number": "954-370-4833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "PHYLLIS",
        "middle_name": "A.",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-06",
        "last_updated": "2011-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP 670502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristina Von Born
• Aditya Vora, D.O.
• Francesco Paul Vultaggio, D.M.D.
• VV Chiropractic Inc.
• Heidi Wagner, O.D.
• Taylor Elizabeth Wagner
• Sarah Elizabeth Wakefield, AU.D.
• Wal-Mart Stores East LP (Walmart Pharmacy 10-2987)
• Wal-Mart Stores East LP (Wal-Mart Vision Center 30-2987)
• Wal-Mart Stores East LP

• Family Nurse Practitioner in Davie, FL
• Providers in Davie, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.