Healthcare Provider Details

I. General information

NPI: 1528064797
Provider Name (Legal Business Name): JOHN L WHEELER ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3236 DR MARTIN LUTHER KING JR ST N
ST PETERSBURG FL
33704-1202
US

IV. Provider business mailing address

3236 DR MARTIN LUTHER KING JR ST N
ST PETERSBURG FL
33704-1202
US

V. Phone/Fax

Practice location:
  • Phone: 727-823-4848
  • Fax: 727-823-4880
Mailing address:
  • Phone: 727-823-4848
  • Fax: 727-823-4880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP2224092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: