Provider Demographics
NPI:1144028879
Name:WIMBERLEY, TODD (APRN)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:WIMBERLEY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12311 W CONFEDERATE DR
Mailing Address - Street 2:
Mailing Address - City:GLEN SAINT MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32040-3871
Mailing Address - Country:US
Mailing Address - Phone:904-548-7236
Mailing Address - Fax:
Practice Address - Street 1:10250 NORMANDY BLVD UNIT 802
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-8064
Practice Address - Country:US
Practice Address - Phone:904-379-7155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11037910363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily