Healthcare Provider Details

I. General information

NPI: 1821917295
Provider Name (Legal Business Name): CAROLYN WILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8351 WESTPORT RD FL 32244
JACKSONVILLE FL
32244-5901
US

IV. Provider business mailing address

2270 NOLAN DR
LARGO FL
33770-4324
US

V. Phone/Fax

Practice location:
  • Phone: 904-317-8811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11048836
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: