Provider Demographics
NPI:1851328629
Name:WHEELER, SONDRA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SONDRA
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:SONDRA
Other - Middle Name:J
Other - Last Name:MOHRMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1601 SW ARCHER RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1135
Mailing Address - Country:US
Mailing Address - Phone:352-548-6000
Mailing Address - Fax:352-374-6103
Practice Address - Street 1:17985 W COUNTY ROAD 1491
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-3171
Practice Address - Country:US
Practice Address - Phone:386-462-3997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100883363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCM8550OtherMEDICARE RR
FL291663100Medicaid
S73951Medicare UPIN
FLE2134Medicare PIN