Active NPI
Julie Lynn Wisham, PA
- Physician Assistant
- Jacksonville, FL
National Provider Identifier
1083397897
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1083397897
- Practice address
- 7807 Baymeadows Rd E Ste 303
Jacksonville, FL 32256-9667 - Phone
- (904) 204-6585
- NPI assigned
- Aug 9, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1083397897 | FL | Primary |
Addresses
Primary practice location
7807 Baymeadows Rd E Ste 303
Jacksonville, FL 32256-9667
Mailing address
11175 Parkside Preserve Way
Jacksonville, FL 32257-1562
Phone (952) 913-7237
Other practice location 1
11175 Parkside Preserve Way
Jacksonville, FL 32257-1562
Phone (952) 913-7237
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231115001066 | FL | Practitioner - Physician Assistant | 6709233604 |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
3003 Claire LN
Suite 100
Jacksonville, FL 32223-6665
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1083397897 | FL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1770940800000",
"number": "1083397897",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11175 PARKSIDE PRESERVE WAY",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322571562",
"telephone_number": "952-913-7237"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7807 BAYMEADOWS RD E STE 303",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322569667",
"telephone_number": "904-204-6585"
}
],
"practiceLocations": [
{
"address_1": "11175 Parkside Preserve Way",
"address_purpose": "LOCATION",
"city": "Jacksonville",
"state": "FL",
"postal_code": "322571562",
"country_code": "US",
"telephone_number": "952-913-7237",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WISHAM",
"first_name": "JULIE",
"middle_name": "LYNN",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-09",
"last_updated": "2026-02-13",
"certification_date": "2026-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "1083397897",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.