1538136817 NPI number — CHARLOTTE WIGLE, ARNP-C, P.A.

Table of content: (NPI 1538136817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538136817 NPI number — CHARLOTTE WIGLE, ARNP-C, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLOTTE WIGLE, ARNP-C, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538136817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35223 HARBOR SHORES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34788-2927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-589-9661
Provider Business Mailing Address Fax Number:
352-589-5983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 N BAY ST STE 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUSTIS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32726-2964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-589-9661
Provider Business Practice Location Address Fax Number:
352-589-5983
Provider Enumeration Date:
03/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WIGLE
Authorized Official First Name:
CHARLOTTE
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
352-589-9661

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  2834222 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 303668500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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