MEDICARE: REGINA R WIMS

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	1041C0700X	Clinical Social Worker	PSW1239	FL

General Provider Information

NPI Number	:	1891496873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA R WIMS

Provider Business Mailing Address
First Line	:	16635 SW 139TH AVE
Second Line	:
City	:	ARCHER
State	:	FL
Zip	:	32618-5311
Country	:	US
Telephone Number	:	352-870-1414
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 NE 25TH AVE STE 104
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34470-5665
Country	:	US
Telephone Number	:	352-870-1414
Fax Number	:

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

Provider Enumeration Date	:	03/15/2023
Last Update Date	:	03/15/2023

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Directions to “ REGINA R WIMS ” Practice Location

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