Healthcare Provider Details

I. General information

NPI: 1679388474
Provider Name (Legal Business Name): JAMES ALLAN WYLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 APPALOOSA TRL
PALM HARBOR FL
34685-2519
US

IV. Provider business mailing address

2512 APPALOOSA TRL
PALM HARBOR FL
34685-2519
US

V. Phone/Fax

Practice location:
  • Phone: 985-774-1489
  • Fax:
Mailing address:
  • Phone: 985-774-1489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11037482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: