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NPI Code Detail

MEDICARE: ROBERT EUGEAN WYNN JR. FNP

MEDICARE: ROBERT EUGEAN WYNN JR. FNP
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
1363LF0000XFamily Nurse PractitionerGAA-NP001117GA
2363L00000XNurse PractitionerAPRN11027815FL

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 : 1972546794
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT EUGEAN WYNN JR. FNP
Provider Business Mailing Address
First Line : 265 WHITE OAK DR
Second Line :
City : PRINCETON
State : WV
Zip : 24740-2973
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 601 E ROLLINS ST
Second Line :
City : ORLANDO
State : FL
Zip : 32803-1248
Country : US
Telephone Number : 407-543-5732
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2006
Last Update Date : 12/29/2025

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