MEDICARE: LASHANDA WIGGINS

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11019924	FL

General Provider Information

NPI Number	:	1386338119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASHANDA WIGGINS

Provider Business Mailing Address
First Line	:	13800 VETERANS WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7401
Country	:	US
Telephone Number	:	407-631-2362
Fax Number	:

Provider Business Practice Location Address
First Line	:	13800 VETERANS WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7401
Country	:	US
Telephone Number	:	407-631-2362
Fax Number	:

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

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	02/03/2026

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