Provider Demographics
NPI:1194697284
Name:WISE, ROSS DAVIN (APRN)
Entity type:Individual
Prefix:MR
First Name:ROSS
Middle Name:DAVIN
Last Name:WISE
Suffix:
Gender:M
Credentials:APRN
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Mailing Address - Street 1:523 BLUE DAZE ST
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-0087
Mailing Address - Country:US
Mailing Address - Phone:904-310-9652
Mailing Address - Fax:904-467-3143
Practice Address - Street 1:1896 S 14TH ST STE 6
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4416
Practice Address - Country:US
Practice Address - Phone:904-310-9652
Practice Address - Fax:904-467-3143
Is Sole Proprietor?:No
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11042360363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health