MEDICARE: CELIA WINES FNP-C

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	363LP2300X	Primary Care Nurse Practitioner	11028718	FL

General Provider Information

NPI Number	:	1366220451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELIA WINES FNP-C

Provider Business Mailing Address
First Line	:	5425 E ANNA JO DR
Second Line	:
City	:	INVERNESS
State	:	FL
Zip	:	34452-8411
Country	:	US
Telephone Number	:	352-220-0122
Fax Number	:

Provider Business Practice Location Address
First Line	:	7648 S FLORIDA AVE
Second Line	:
City	:	FLORAL CITY
State	:	FL
Zip	:	34436-2738
Country	:	US
Telephone Number	:	352-726-3700
Fax Number	:	352-726-8570

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

Provider Enumeration Date	:	09/19/2023
Last Update Date	:	12/30/2024

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