Provider Demographics
NPI:1538136817
Name:CHARLOTTE WIGLE, ARNP-C, P.A.
Entity Type:Organization
Organization Name:CHARLOTTE WIGLE, ARNP-C, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WIGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ARNP-C
Authorized Official - Phone:352-589-9661
Mailing Address - Street 1:35223 HARBOR SHORES RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-2927
Mailing Address - Country:US
Mailing Address - Phone:352-589-9661
Mailing Address - Fax:352-589-5983
Practice Address - Street 1:720 N BAY ST STE 11
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-2964
Practice Address - Country:US
Practice Address - Phone:352-589-9661
Practice Address - Fax:352-589-5983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-04
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2834222363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303668500Medicaid
Y9907Medicare ID - Type Unspecified
FL303668500Medicaid