Provider Demographics
NPI:1821960667
Name:WOLF, RENAN (APRN)
Entity type:Individual
Prefix:
First Name:RENAN
Middle Name:
Last Name:WOLF
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6328 GUNN HWY STE B
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-4101
Mailing Address - Country:US
Mailing Address - Phone:813-964-8526
Mailing Address - Fax:813-964-8536
Practice Address - Street 1:6328 GUNN HWY STE B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4101
Practice Address - Country:US
Practice Address - Phone:813-964-8526
Practice Address - Fax:813-964-8536
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11040285207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty