Individual
MRS. BOLIVIA EARLINE WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
5016 14TH AVE S, GULFPORT, FL 33707-3625
(727) 748-3367
Mailing address
5016 14TH AVE S, GULFPORT, FL 33707-3625
(727) 748-3367
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN9403819
FL
Other
Enumeration date
01/20/2017
Last updated
01/20/2017
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