Provider Demographics
NPI:1306593066
Name:WYCOFF, CURTIS
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:
Last Name:WYCOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 FIRESTONE ST NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-2052
Mailing Address - Country:US
Mailing Address - Phone:321-914-6765
Mailing Address - Fax:
Practice Address - Street 1:618 FIRESTONE ST NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2052
Practice Address - Country:US
Practice Address - Phone:321-914-6765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9468188163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse