Provider Demographics
NPI:1962066647
Name:WIELOSZYNSKI, MICHAEL (LPN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WIELOSZYNSKI
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 W OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-3701
Mailing Address - Country:US
Mailing Address - Phone:407-251-6000
Mailing Address - Fax:
Practice Address - Street 1:17036 GLORYANNA DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-9776
Practice Address - Country:US
Practice Address - Phone:407-949-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-28
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5216351164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse