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General NPI Number Information
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NPI Number | 1407203110
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Entity Type | Individual
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Provider Name | GYLA ANN WISE ARNP
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Gender | Female
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | 402 W MAIN ST
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City | IMMOKALEE
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State | FL
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Zip | 34142-3933
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Country | US
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Telephone | 239-658-3560
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Fax | 239-658-3571
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Provider Business Mailing Address
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Address Line | 402 W MAIN ST
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City | IMMOKALEE
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State | FL
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Zip | 34142-3933
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Country | US
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Telephone | 239-658-3560
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Fax | 239-658-3571
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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 | ARNP 1217282
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License Number State | FL
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