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General NPI Number Information
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NPI Number | 1144028879
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Entity Type | Individual
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Provider Name | TODD WIMBERLEY APRN
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Gender | Male
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Dates
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Enumeration Date | 03/06/2025
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 10250 NORMANDY BLVD UNIT 802
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City | JACKSONVILLE
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State | FL
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Zip | 32221-8064
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Country | US
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Telephone | 904-379-7155
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Fax |
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Provider Business Mailing Address
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Address Line | 12311 W CONFEDERATE DR
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City | GLEN SAINT MARY
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State | FL
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Zip | 32040-3871
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Country | US
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Telephone | 904-548-7236
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11037910
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License Number State | FL
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