Provider Demographics
NPI:1043766579
Name:WIGGINGS, RENAYE
Entity Type:Individual
Prefix:
First Name:RENAYE
Middle Name:
Last Name:WIGGINGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4022 GREENMARK LN
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7022
Mailing Address - Country:US
Mailing Address - Phone:813-654-7171
Mailing Address - Fax:
Practice Address - Street 1:4022 GREENMARK LN
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-7022
Practice Address - Country:US
Practice Address - Phone:813-654-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide