Provider Demographics
NPI:1295585016
Name:FANTROY, WYKINDA TUMESA (FNP-C)
Entity type:Individual
Prefix:
First Name:WYKINDA
Middle Name:TUMESA
Last Name:FANTROY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 N GARRISON ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-1543
Mailing Address - Country:US
Mailing Address - Phone:813-789-2262
Mailing Address - Fax:
Practice Address - Street 1:3607 N GARRISON ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-1543
Practice Address - Country:US
Practice Address - Phone:813-789-2262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF03240335207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine