Provider Demographics
NPI:1144535808
Name:WAGNER, ADRIANA (PMHNP-BC, LMHC)
Entity type:Individual
Prefix:MS
First Name:ADRIANA
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:PMHNP-BC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 PANKAW LN
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6515
Mailing Address - Country:US
Mailing Address - Phone:813-598-8482
Mailing Address - Fax:
Practice Address - Street 1:26601 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33982-2408
Practice Address - Country:US
Practice Address - Phone:941-833-6300
Practice Address - Fax:941-833-6300
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10983101YM0800X, 101YA0400X
FLNP110389782084P0800X
FLCAP 4364101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101YM0800XMedicaid