Individual
WILDWINE BELIZAIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
7560 BUTNER RD, FAIRBURN, GA 30213-1914
(800) 266-8874
(877) 366-4776
Mailing address
3800 S OCEAN DR STE 209, HOLLYWOOD, FL 33019-2915
(800) 226-8874
(877) 366-4776
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN315873
GA
Other
Enumeration date
05/15/2023
Last updated
07/18/2026
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