Provider Demographics
NPI:1366131419
Name:PARKER, WANDA
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 TAMARA DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6622
Mailing Address - Country:US
Mailing Address - Phone:850-736-2782
Mailing Address - Fax:
Practice Address - Street 1:17 S. DE VILLIERS STREET
Practice Address - Street 2:PENSACOLA, FLORIDA 32502
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-3250
Practice Address - Country:US
Practice Address - Phone:850-266-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker