MEDICARE: CHARLOTTE WIGLE, ARNP-C, P.A.

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

General Provider Information

NPI Number	:	1538136817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLOTTE WIGLE, ARNP-C, P.A.

Provider Business Mailing Address
First Line	:	35223 HARBOR SHORES RD
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34788-2927
Country	:	US
Telephone Number	:	352-589-9661
Fax Number	:	352-589-5983

Provider Business Practice Location 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

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. CHARLOTTE A. WIGLE
Credential	:	M.S., ARNP-C
Telephone Number	:	352-589-9661

Provider Enumeration Date	:	03/04/2006
Last Update Date	:	12/29/2009

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