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NPI Code Detail

MEDICARE: LATASHA WILEY

MEDICARE: LATASHA WILEY
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 PractitionerAPRN11005781FL

Other Identifiers

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

General Provider Information

NPI Number : 1821628207
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATASHA WILEY
Provider Business Mailing Address
First Line : 4280 SOUTHSIDE BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-5400
Country : US
Telephone Number : 904-998-3677
Fax Number : 904-998-4027
Provider Business Practice Location Address
First Line : 4280 SOUTHSIDE BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-5400
Country : US
Telephone Number : 904-998-3677
Fax Number : 904-998-4027
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2020
Last Update Date : 06/22/2026

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Directions to “ LATASHA WILEY ” Practice Location

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