Basic Information
| Provider Information | |||||||||
| NPI: | 1578694832 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WISBY | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ADKINS | ||||||||
| OtherFirstName: | KAREN | ||||||||
| OtherMiddleName: | KAYE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 14690 SPRING HILL DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346098102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527990046 | ||||||||
| FaxNumber: | 3526062857 | ||||||||
| Practice Location | |||||||||
| Address1: | 5798 38TH AVENUE NORTH | ||||||||
| Address2: | |||||||||
| City: | ST. PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273840192 | ||||||||
| FaxNumber: | 7273841500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP1457132 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 308214800 | 01 | FL | MEDIPASS | OTHER | 15606901 | 01 | FL | CITRUS-49TH STREET | OTHER | 15606902 | 01 | FL | CITRUS-PASADENA AVE S | OTHER | P00441591 | 01 | FL | RAILROAD MEDICARE | OTHER | 1063472 | 01 | FL | CAREPLUS | OTHER | 308214800 | 05 | FL | MEDICAID | Y116T | 01 | FL | BLUE CROSS BLUE SHIELD OF FL | OTHER | 15606903 | 01 | FL | CITRUS-WEST BAY | OTHER | P06060 | 01 | FL | FREEDOM HEALTH | OTHER | 3082148 | 01 | FL | MEDIPASS | OTHER | 308246 | 01 | FL | AVMED | OTHER |