Healthcare Provider Details

I. General information

NPI: 1992260228
Provider Name (Legal Business Name): CHIARA WESLEY NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3465 VILLAGE CENTER DR
JACKSONVILLE FL
32206-8617
US

IV. Provider business mailing address

3465 VILLAGE CENTER DR
JACKSONVILLE FL
32206-8617
US

V. Phone/Fax

Practice location:
  • Phone: 904-383-1040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9359347
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: