Individual
MRS. JACQUELINE PAULA WIESNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13180 N CLEVELAND AVE STE 117, NORTH FORT MYERS, FL 33903-6230
(239) 218-3764
Mailing address
4312 S GULF CIR, NORTH FORT MYERS, FL 33903-5046
(239) 218-3764
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA13010
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
675966100
—
FL
Enumeration date
12/20/2017
Last updated
06/18/2019
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