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NPI Code Detail

MEDICARE: LAKESHIA WYNN

MEDICARE: LAKESHIA WYNN
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
1363LF0000XFamily Nurse PractitionerAPRN9399245FL

General Provider Information

NPI Number : 1649771239
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAKESHIA WYNN
Provider Business Mailing Address
First Line : PO BOX 82969
Second Line :
City : TAMPA
State : FL
Zip : 33682-2969
Country : US
Telephone Number : 813-866-0930
Fax Number :
Provider Business Practice Location Address
First Line : 7608 CAUSEWAY BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33619-5912
Country : US
Telephone Number : 813-397-5300
Fax Number : 813-738-9004
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2018
Last Update Date : 05/10/2024

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Directions to “ LAKESHIA WYNN ” Practice Location

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