Healthcare Provider Details

I. General information

NPI: 1073511481
Provider Name (Legal Business Name): JENNIFER L. WICKS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER L. ENSCOE

II. Dates (important events)

Enumeration Date: 07/09/2005
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TAMPA GENERAL CIR STC 5TH FLOOR
TAMPA FL
33606-3603
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 813-259-0600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP9343457
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: