Provider Demographics
NPI:1346593647
Name:WIMMER, DEREK PAUL (PA-C)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:PAUL
Last Name:WIMMER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3384 WOODS EDGE CIR STE 104
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-1367
Mailing Address - Country:US
Mailing Address - Phone:239-829-4300
Mailing Address - Fax:
Practice Address - Street 1:3384 WOODS EDGE CIR STE 104
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-1367
Practice Address - Country:US
Practice Address - Phone:239-829-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical