Provider Demographics
NPI:1790799070
Name:WIK, SHELLY J (ARNP-C, MSN)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:J
Last Name:WIK
Suffix:
Gender:F
Credentials:ARNP-C, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 W HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1401
Mailing Address - Country:US
Mailing Address - Phone:954-360-7000
Mailing Address - Fax:954-360-7511
Practice Address - Street 1:1861 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1401
Practice Address - Country:US
Practice Address - Phone:954-360-7000
Practice Address - Fax:954-360-7511
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNP2613302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily