Provider Demographics
NPI:1689921892
Name:WHEELER, JARVIS AC (MSW,MPA)
Entity Type:Individual
Prefix:MR
First Name:JARVIS
Middle Name:AC
Last Name:WHEELER
Suffix:
Gender:M
Credentials:MSW,MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6209 WESTGATE DR APT 1110
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-7074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3270 SUNTREE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7540
Practice Address - Country:US
Practice Address - Phone:321-610-7949
Practice Address - Fax:321-610-7947
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLW460-421-87-310-0104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker