Healthcare Provider Details

I. General information

NPI: 1346600558
Provider Name (Legal Business Name): COURTNEY WILDER-WHITING FNP-C, PMHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY MCENTIRE FNP

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 E FOWLER AVE # 601
TAMPA FL
33612-6297
US

IV. Provider business mailing address

2780 E FOWLER AVE # 601
TAMPA FL
33612-6297
US

V. Phone/Fax

Practice location:
  • Phone: 813-444-2276
  • Fax: 614-412-2522
Mailing address:
  • Phone: 813-444-2276
  • Fax: 614-412-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11024193
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP70132570
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18936
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberPMH01260116
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-RNP341026
License Number StateAZ
# 6
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberPMH01260116
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.18936
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11024193
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: