Provider Demographics
NPI:1639313000
Name:WIMS, JAMES L (CST/CSFA/SA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:L
Last Name:WIMS
Suffix:
Gender:M
Credentials:CST/CSFA/SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1830
Mailing Address - Street 2:619 N.E. 7TH AVE.
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34423-1830
Mailing Address - Country:US
Mailing Address - Phone:352-563-7032
Mailing Address - Fax:
Practice Address - Street 1:10495 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:CITRUS SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34434-3268
Practice Address - Country:US
Practice Address - Phone:352-465-5663
Practice Address - Fax:352-465-5664
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL105719246ZS0410X
FL117931246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist