Provider Demographics
NPI:1891263463
Name:WIGGINS, TAMESHIA (PMHNP-BC,AGNP-C)
Entity type:Individual
Prefix:
First Name:TAMESHIA
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:PMHNP-BC,AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 HEATHERDOWNS BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-4644
Mailing Address - Country:US
Mailing Address - Phone:419-314-9535
Mailing Address - Fax:419-469-5495
Practice Address - Street 1:5330 HEATHERDOWNS BLVD STE 207
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-4644
Practice Address - Country:US
Practice Address - Phone:419-314-9535
Practice Address - Fax:419-469-5495
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV847075363LA2200X, 363LG0600X
OHAPRN.CNP.023855363LA2200X, 363LG0600X, 363LP0808X
NC5017112363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty