Wanda B Liddell, ARNP

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1569472 Issued in FL

Practice address

306 NE Hwy 351
Cross City, FL 32628

Phone

(352) 498-3372

Fax

(352) 498-7119

NPI assigned

Nov 27, 2006

Sex

Female

Sole proprietor

No

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

• Tri-County Primary Care Inc

  • Rural Health Clinic/Center
  • Cross City, FL
  • NPI 1437225067

  Family Medicine, FL

  Medicare reassignment NPD
• GNT Associates, LLC

  • Internal Medicine Physician
  • Cross City, FL
  • NPI 1649543869
  NPD

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Tri-County Primary Care Inc

  • Rural Health Clinic/Center
  • Cross City, FL
  • NPI 1437225067

  Corporate Director, Operational/Managerial Control

  CMS ownership

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

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649346271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 NE HWY 351",
            "city": "CROSS CITY",
            "state": "FL",
            "postal_code": "32628",
            "telephone_number": "352-498-3372",
            "fax_number": "352-498-7119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 NE HWY 351",
            "city": "CROSS CITY",
            "state": "FL",
            "postal_code": "32628",
            "telephone_number": "352-498-3372",
            "fax_number": "352-498-7119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIDDELL",
        "first_name": "WANDA",
        "middle_name": "B",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "1569472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Y7250",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Johnnie Mae Grimes
• Taylor Mae Jones, STUDENT
• Kinder Cub School, Inc
• Dena Temeka Kirkland
• John Clifford Knight, PHYSICIANS ASSISTANT
• Maria Lili Jo Catalan Miller, ARNP
• North Florida Medical Centers, Inc.
• North Florida Pediatrics PA
• North Florida Pediatrics, PA
• Virginia Kay Overstreet

• All providers in Cross City, FL
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.