Provider Demographics
NPI:1861010860
Name:WILEY, RACHELLE ANNE (ARNP)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:ANNE
Last Name:WILEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 WIMPOLE LN SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-3374
Mailing Address - Country:US
Mailing Address - Phone:321-652-4922
Mailing Address - Fax:
Practice Address - Street 1:390 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3456
Practice Address - Country:US
Practice Address - Phone:321-633-3162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007793363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner