Individual
BRIAN E WICKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2352 BRUCE B DOWNS BLVD STE 102, WESLEY CHAPEL, FL 33544-9203
(813) 979-0440
Mailing address
38135 MARKET SQUARE DR, ZEPHYRHILLS, FL 33542-7505
(352) 567-0188
(813) 355-5101
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9105658
FL
363AM0700X
Medical Physician Assistant
PA9105658
FL
363AS0400X
Surgical Physician Assistant
Primary
PA9105658
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002748200
—
FL
01
—
Y05NE
BCBS
FL
Enumeration date
09/21/2010
Last updated
07/28/2022
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