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General NPI Number Information
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NPI Number | 1194697284
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Entity Type | Individual
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Provider Name | ROSS DAVIN WISE APRN
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Gender | Male
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Dates
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Enumeration Date | 09/19/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 1896 S 14TH ST STE 6
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-4416
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Country | US
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Telephone | 904-310-9652
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Fax | 904-467-3143
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Provider Business Mailing Address
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Address Line | 523 BLUE DAZE ST
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City | YULEE
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State | FL
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Zip | 32097-0087
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Country | US
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Telephone | 904-310-9652
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Fax | 904-467-3143
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11042360
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License Number State | FL
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