Healthcare Provider Details

I. General information

NPI: 1689325532
Provider Name (Legal Business Name): MARISSA KATHRYN WHEELER RT (R)(MR)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

7891 SW 82ND DR
GAINESVILLE FL
32608-9524
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0111
  • Fax:
Mailing address:
  • Phone: 352-514-3930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License NumberCRT82658
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: