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NPI Code Detail

MEDICARE: TERRY L WILDER APRN

MEDICARE: TERRY L WILDER APRN
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
1363L00000XNurse PractitionerAPRN1708892FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518906072
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY L WILDER APRN
Provider Business Mailing Address
First Line : 1707 N MILLS AVE
Second Line :
City : ORLANDO
State : FL
Zip : 32803-1851
Country : US
Telephone Number : 407-647-3960
Fax Number : 407-647-3960
Provider Business Practice Location Address
First Line : 1707 N MILLS AVE
Second Line :
City : ORLANDO
State : FL
Zip : 32803-1851
Country : US
Telephone Number : 407-647-3960
Fax Number : 407-830-4164
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2006
Last Update Date : 05/08/2024

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Directions to “ TERRY L WILDER APRN” Practice Location

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