Provider Demographics
NPI:1639879091
Name:WYMER, HEIDI SUZANNE
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:SUZANNE
Last Name:WYMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CRANES LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-1610
Mailing Address - Country:US
Mailing Address - Phone:386-438-4656
Mailing Address - Fax:
Practice Address - Street 1:117 CRANES LAKE DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-1610
Practice Address - Country:US
Practice Address - Phone:386-438-4656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9314353163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse