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NPI Code Detail

MEDICARE: KADY NICOLE WISE PA

MEDICARE: KADY NICOLE WISE PA
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
1363A00000XPhysician Assistant9110125FL

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 : 1881139491
Entity Type Code : Individual
Provider Name (Legal Business Name) : KADY NICOLE WISE PA
Provider Business Mailing Address
First Line : 900 S PINE ISLAND RD STE 800
Second Line :
City : PLANTATION
State : FL
Zip : 33324-3923
Country : US
Telephone Number : 954-967-6400
Fax Number : 954-337-5755
Provider Business Practice Location Address
First Line : 596 COURTLAND BLVD
Second Line :
City : DELTONA
State : FL
Zip : 32738-8902
Country : US
Telephone Number : 407-249-1234
Fax Number : 407-249-1755
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2017
Last Update Date : 01/17/2024

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Directions to “ KADY NICOLE WISE PA” Practice Location

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