Provider Demographics
NPI:1386005015
Name:WILDER, CLEOPATRA (CSFA)
Entity type:Individual
Prefix:MRS
First Name:CLEOPATRA
Middle Name:
Last Name:WILDER
Suffix:
Gender:
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4513 TRAMANTO LN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-2511
Mailing Address - Country:US
Mailing Address - Phone:813-244-2012
Mailing Address - Fax:
Practice Address - Street 1:4513 TRAMANTO LN
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-2511
Practice Address - Country:US
Practice Address - Phone:813-244-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant