Provider Demographics
NPI:1700401635
Name:WHEELER, DAKOTA SHARON PHILLIPS (RN)
Entity Type:Individual
Prefix:
First Name:DAKOTA
Middle Name:SHARON PHILLIPS
Last Name:WHEELER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5045 KIRKWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-6717
Mailing Address - Country:US
Mailing Address - Phone:407-496-3651
Mailing Address - Fax:
Practice Address - Street 1:5045 KIRKWOOD TRL
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-6717
Practice Address - Country:US
Practice Address - Phone:407-496-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3391752163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice