Provider Demographics
NPI:1407686793
Name:WIGGLESWORTH, FAITH L (LPN)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:L
Last Name:WIGGLESWORTH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 HOLLY HILL DR
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-2707
Mailing Address - Country:US
Mailing Address - Phone:407-274-4805
Mailing Address - Fax:
Practice Address - Street 1:603 HOLLY HILL DR
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-2707
Practice Address - Country:US
Practice Address - Phone:407-274-4805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5172413164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse