Healthcare Provider Details

I. General information

NPI: 1518821917
Provider Name (Legal Business Name): TUWANA WIGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8223 HUB WAY APT 106
CHARLOTTE NC
28227-1151
US

IV. Provider business mailing address

8223 HUB WAY APT 106
CHARLOTTE NC
28227-1151
US

V. Phone/Fax

Practice location:
  • Phone: 305-783-0770
  • Fax:
Mailing address:
  • Phone: 305-783-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: