Provider Demographics
NPI:1881379782
Name:MANLEY, WILMA JEANETTE (APRN)
Entity type:Individual
Prefix:MRS
First Name:WILMA
Middle Name:JEANETTE
Last Name:MANLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 VALRICO VISTA DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-3243
Mailing Address - Country:US
Mailing Address - Phone:813-365-3525
Mailing Address - Fax:
Practice Address - Street 1:1905 W BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7675
Practice Address - Country:US
Practice Address - Phone:813-365-3525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily