Individual
MR. SEAN M WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN-C
Contact information
Practice address
1919 W SWANN AVE FL 2, TAMPA, FL 33606-2417
(813) 254-7079
(813) 443-8164
Mailing address
2995 DREW ST FL 2, CLEARWATER, FL 33759-3012
(727) 532-1355
(813) 635-2613
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
28224842A
IN
363LP2300X
Primary Care Nurse Practitioner
Primary
APRN11001912
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102642600
—
FL
Enumeration date
07/09/2015
Last updated
05/08/2019
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