Provider Demographics
NPI:1235138520
Name:WIGHTMAN, WENDY (NP)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:WIGHTMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 E FLETCHER AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4656
Mailing Address - Country:US
Mailing Address - Phone:813-972-5090
Mailing Address - Fax:813-975-8748
Practice Address - Street 1:3000 E FLETCHER AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4656
Practice Address - Country:US
Practice Address - Phone:813-972-5090
Practice Address - Fax:813-975-8748
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2606242363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6239WMedicare ID - Type Unspecified