Provider Demographics
NPI:1528212826
Name:WIGGAN, DAHLIA GLADOLA (ARNP)
Entity Type:Individual
Prefix:
First Name:DAHLIA
Middle Name:GLADOLA
Last Name:WIGGAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 NE 204TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-2436
Mailing Address - Country:US
Mailing Address - Phone:305-725-8836
Mailing Address - Fax:
Practice Address - Street 1:652 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33311-1728
Practice Address - Country:US
Practice Address - Phone:305-814-4947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2012322363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner