Individual
LESLINE WALLACE WILDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.A.
Contact information
Practice address
3100 E FLETCHER AVE, TAMPA, FL 33613-4613
(813) 615-7914
(813) 615-8134
Mailing address
3100 E FLETCHER AVE, TAMPA, FL 33613-4613
(813) 615-7914
(813) 615-8134
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP918952
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
034811200
—
FL
01
—
430028310
RAILROAD MEDICARE
—
01
—
G0431
BCBS
FL
Enumeration date
11/18/2005
Last updated
10/23/2008
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