Healthcare Provider Details

I. General information

NPI: 1083263065
Provider Name (Legal Business Name): ERICA I. WESNER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DR
BALTIMORE MD
21237-3901
US

IV. Provider business mailing address

1401 CENTERVILLE RD STE 100
TALLAHASSEE FL
32308-4638
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-7000
  • Fax:
Mailing address:
  • Phone: 850-877-5183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116024
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0007297
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: