MEDICARE: ANZOLA WIGGINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRNCNP880058	NV
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11015633	FL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRNRNP283627	AZ
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	GAA-NP000425	GA
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP61504047	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154092245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANZOLA WIGGINS

Provider Business Mailing Address
First Line	:	3122 MAHAN DR STE 801-308
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-2500
Country	:	US
Telephone Number	:	850-570-0522
Fax Number	:

Provider Business Practice Location Address
First Line	:	3122 MAHAN DR STE 801-308
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-2500
Country	:	US
Telephone Number	:	850-570-0522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2021
Last Update Date	:	12/08/2025

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Directions to “ ANZOLA WIGGINS ” Practice Location

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