MEDICARE: SHELLY J WIK ARNP-C, MSN

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	363LF0000X	Family Nurse Practitioner	NP2613302	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	:	1790799070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY J WIK ARNP-C, MSN

Provider Business Mailing Address
First Line	:	1861 W HILLSBORO BLVD
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-1401
Country	:	US
Telephone Number	:	954-360-7000
Fax Number	:	954-360-7511

Provider Business Practice Location Address
First Line	:	1861 W HILLSBORO BLVD
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-1401
Country	:	US
Telephone Number	:	954-360-7000
Fax Number	:	954-360-7511

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

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	07/08/2007

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