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NPI Code Detail

MEDICARE: MRS. MARY K WIGGS ARNP

MEDICARE: MRS. MARY K WIGGS ARNP
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 PractitionerAPRN9422930FL
2363LF0000XFamily Nurse Practitioner9243546FL
3363L00000XNurse PractitionerRN133916GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1133916OTHERGAMEDICAL LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831149392
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY K WIGGS ARNP
Provider Business Mailing Address
First Line : 555 N BYRON BUTLER PKWY
Second Line :
City : PERRY
State : FL
Zip : 32347-2315
Country : US
Telephone Number : 850-223-5409
Fax Number : 850-223-5402
Provider Business Practice Location Address
First Line : 555 N BYRON BUTLER PKWY
Second Line :
City : PERRY
State : FL
Zip : 32347-2315
Country : US
Telephone Number : 850-223-5409
Fax Number : 850-223-5402
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2006
Last Update Date : 06/23/2020

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