Healthcare Provider Details

I. General information

NPI: 1659197317
Provider Name (Legal Business Name): LINDSAY WIBERLY MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21859 FL-54
LUTZ FL
33549
US

IV. Provider business mailing address

4648 JERRILYN CT
NEW PORT RICHEY FL
34653-6724
US

V. Phone/Fax

Practice location:
  • Phone: 727-808-1606
  • Fax:
Mailing address:
  • Phone: 727-808-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11035709
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: