MEDICARE: MS. CHARLOTTE ANN WIGLE ARNP-

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	2834222	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2834222	OTHER	FL	ARNP LICENSE NUMBER

General Provider Information

NPI Number	:	1265534747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHARLOTTE ANN WIGLE ARNP-

Provider Business Mailing Address
First Line	:	720 N BAY ST STE 11
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32726-2964
Country	:	US
Telephone Number	:	352-589-9661
Fax Number	:	352-589-5983

Provider Business Practice Location Address
First Line	:	801 N BAY ST
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32726-2941
Country	:	US
Telephone Number	:	352-589-9661
Fax Number	:	352-589-2458

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2006
Last Update Date	:	10/10/2014

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