Individual
MAXINE WIGGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
929 GILMORE AVE, LAKELAND, FL 33801-1887
(407) 575-5683
Mailing address
15144 SPINNAKER COVE LN, WINTER GARDEN, FL 34787-4732
(407) 575-5683
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
163WG0000X
General Practice Registered Nurse
RN 9174105
FL
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/16/2015
Last updated
03/15/2016
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