Healthcare Provider Details

I. General information

NPI: 1164883690
Provider Name (Legal Business Name): JODIE NICOLE WILKE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20360 GATOR LN BLDG 14
LAND O LAKES FL
34638-2802
US

IV. Provider business mailing address

16911 ROLLING ROCK DR
TAMPA FL
33618-1140
US

V. Phone/Fax

Practice location:
  • Phone: 813-346-3400
  • Fax:
Mailing address:
  • Phone: 402-730-0480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9494602
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: