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General NPI Number Information
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NPI Number | 1467200030
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Entity Type | Individual
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Provider Name | HEATHER NICOLE WILBUR PMHNP
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Gender | Female
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Dates
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Enumeration Date | 05/08/2024
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 2400 E COMMERCIAL BLVD STE 101
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-4022
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Country | US
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Telephone | 833-769-3524
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Fax | 954-756-9582
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Provider Business Mailing Address
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Address Line | 510 SE 5TH AVE APT 609
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-2994
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Country | US
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Telephone | 585-794-9059
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11032699
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License Number State | FL
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