Healthcare Provider Details

I. General information

NPI: 1366220451
Provider Name (Legal Business Name): CELIA WINES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7648 S FLORIDA AVE
FLORAL CITY FL
34436-2738
US

IV. Provider business mailing address

5425 E ANNA JO DR
INVERNESS FL
34452-8411
US

V. Phone/Fax

Practice location:
  • Phone: 352-726-3700
  • Fax: 352-726-8570
Mailing address:
  • Phone: 352-220-0122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11028718
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: