Individual
LATASHA WILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11698 ALEXANDRA DR, JACKSONVILLE, FL 32218-8874
(904) 598-4229
Mailing address
11698 ALEXANDRA DR, JACKSONVILLE, FL 32218-8874
(904) 598-4229
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
APRN11005781
FL
Other
Enumeration date
01/24/2020
Last updated
01/24/2020
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