Provider Demographics
NPI:1891263463
Name:WIGGINS, TAMESHIA (PMHNP-BC,AGNP-C)
Entity Type:Individual
Prefix:
First Name:TAMESHIA
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:PMHNP-BC,AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 INDIAN WOOD CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-4055
Mailing Address - Country:US
Mailing Address - Phone:419-314-9535
Mailing Address - Fax:419-469-5495
Practice Address - Street 1:1715 INDIAN WOOD CIR STE 200
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4055
Practice Address - Country:US
Practice Address - Phone:866-279-8665
Practice Address - Fax:419-469-5495
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2024-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023855363LG0600X, 363LP0808X, 363LA2200X
NV847075363LG0600X, 363LA2200X
NC5017112363LP0808X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health