MEDICARE: WYKINDA TUMESA FANTROY FNP-C

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	207Q00000X	Family Medicine Physician	F03240335	FL

General Provider Information

NPI Number	:	1295585016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WYKINDA TUMESA FANTROY FNP-C

Provider Business Mailing Address
First Line	:	3607 N GARRISON ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-1543
Country	:	US
Telephone Number	:	813-789-2262
Fax Number	:

Provider Business Practice Location Address
First Line	:	3607 N GARRISON ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-1543
Country	:	US
Telephone Number	:	813-789-2262
Fax Number	:

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

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/25/2024

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