Provider Demographics
NPI:1851145643
Name:WIMS EXECUTIVE HOLDINGS
Entity Type:Organization
Organization Name:WIMS EXECUTIVE HOLDINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIMS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:904-599-6789
Mailing Address - Street 1:11756 CHERRY BARK DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-8614
Mailing Address - Country:US
Mailing Address - Phone:904-599-6789
Mailing Address - Fax:
Practice Address - Street 1:11756 CHERRY BARK DR E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-8614
Practice Address - Country:US
Practice Address - Phone:904-599-6789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care