Bethany Danielle Wisniewski, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9116636 Issued in FL

Practice address

6150 Diamond Centre CT Unit 1200
Fort Myers, FL 33912-7135

Phone

(239) 344-9786

NPI assigned

Oct 19, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: bethany.wisniewski.1@26455.direct.athenahealth.com

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

{
    "created_epoch": "1666137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739404800000",
    "number": "1619693702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3040 OASIS GRAND BLVD APT 2202",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339161607",
            "telephone_number": "561-779-0610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6150 DIAMOND CENTRE CT UNIT 1200",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339127135",
            "telephone_number": "239-344-9786"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1995 E Oakland Park Blvd Ste 310",
            "address_purpose": "LOCATION",
            "city": "Fort Lauderdale",
            "state": "FL",
            "postal_code": "333061138",
            "country_code": "US",
            "telephone_number": "954-791-6146",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISNIEWSKI",
        "first_name": "BETHANY",
        "middle_name": "DANIELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-19",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9116636",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9116636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine E Wirth, ARNP
• Serina Wirth
• Jaclyn Wise, PA-C
• Marci Wise
• Shannon Elizabeth Wiseley, LMHC
• Emily Withington
• Wittenborn Plastic Surgery LLC
• William Scott Wittenborn, M.D.
• Karlene Witter, PA
• Aaron Wohl, MD

• Surgical Physician Assistant in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; 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.