Provider Demographics
NPI:1013582899
Name:WIGGINS, NICOLE (NP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 NORFOLK PKWY STE 114
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-8617
Mailing Address - Country:US
Mailing Address - Phone:321-341-3321
Mailing Address - Fax:
Practice Address - Street 1:4311 NORFOLK PKWY STE 114
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-8617
Practice Address - Country:US
Practice Address - Phone:321-341-3321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11023496363LF0000X
NC5014454363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty