Healthcare Provider Details

I. General information

NPI: 1487074274
Provider Name (Legal Business Name): JENNY WYLIE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18TH MEDICAL GROUP, UNIT 5142
APO AP
96368-5142
US

IV. Provider business mailing address

PSC 80 BOX 14073
APO AP
96367-0043
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-4970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP 9361410
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: