Individual
JOHNNETTA NICOLE WIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
5523 KILCULLEN LN, JACKSONVILLE, FL 32244-6258
(904) 672-7820
Mailing address
5523 KILCULLEN LN, JACKSONVILLE, FL 32244-6258
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
2911422
FL
Other
Enumeration date
07/23/2013
Last updated
07/23/2013
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