Look up the most recent NPI and PECOS records

Agnes Wozniak Wahl

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

4500 San Pablo Rd S, Jacksonville, FL 32224

(904) 953-2000

PECOS Enrollment

This provider is enrolled in PECOS as AGNES WAHL.

Based on the most recent information from CMS, provider Agnes Wozniak Wahl is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 8 days ago.

Profile Details

Provider ID
1366952251
Provider Type
Individual
Full Name
Wahl, Agnes Wozniak
Credential
NURSE PRACTITIONER

Gender
Female
Sole Proprietor
No
Enumeration Date
10/4/2017
Last Updated
11/15/2018

Contact Information

Practice Location

4500 San Pablo Rd S, Jacksonville, FL 32224

(904) 953-2000

Unlisted Fax

Mailing Location

4500 San Pablo Rd S, Jacksonville, FL 32224-1865

(904) 953-2000

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363L00000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 9337637 Florida
Code 363LF0000X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 0993433 Colorado

Agnes Wozniak Wahl

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Esomonu, Chinenye

Collins, Christina I

Moreno-Lackman, Andrea

Sheridan-Young, Jean

Wylie, Natasha Subhan

Proto-Conroy, Kimberly

Finch, Danielle

Mullen, Kathleen Ellen

Matos, Nikki

Tyle, Veronica Fernicola