Provider Demographics
NPI:1194950030
Name:WHEELER, JENNIFER (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 W SEMINOLE BLVD
Mailing Address - Street 2:CENTRAL FLORIDA REGIONAL HOSPITAL
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6743
Mailing Address - Country:US
Mailing Address - Phone:407-321-4500
Mailing Address - Fax:
Practice Address - Street 1:1401 W SEMINOLE BLVD
Practice Address - Street 2:CENTRAL FLORIDA REGIONAL HOSPITAL
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-6743
Practice Address - Country:US
Practice Address - Phone:407-321-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103459363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1194950030Medicare UPIN
FL1194950030Medicare PIN
FL1194950030Medicare NSC