Individual provider Active NPI

Rachel Rodrigo Wiik, ARNP

  • Pediatric Nurse Practitioner
  • Lehigh Acres, FL
National Provider Identifier
1154058634
Registry record updated Dec 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
APRN11012859 Issued in FL
Practice address
260 Beth Stacey Blvd Ste C
Lehigh Acres, FL 33936-6074
Phone
(239) 343-9888
NPI assigned
Aug 4, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X APRN11012859 FL
Pediatric Nurse Practitioner 363LP0200X APRN11012859 FL Primary

Addresses

Primary practice location

260 Beth Stacey Blvd Ste C
Lehigh Acres, FL 33936-6074

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (239) 343-9888

Other practice location 1

4751 S Cleveland Ave
Fort Myers, FL 33907-1317
Phone (239) 343-9888

Other identifiers 1

IdentifierTypeStateIssuer
115415100MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rwiik308257@Direct.leememorial.org Direct Lee Memorial Health System

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220830002633 FL Practitioner - Nurse Practitioner 6507086766 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lee Health System Inc CurrentSince Oct 1, 2024 Accepting new patients
Lee Memorial Health System CurrentSince Oct 9, 2022 Accepting new patients
Lee Memorial Health System Pediatrics CurrentSince Oct 9, 2022 Accepting new patients
Lee Health System Inc Pediatrics CurrentSince Oct 1, 2024 Accepting new patients

Locations

1138 Country Club Blvd
Cape Coral, FL 33990
Phone (239) 424-1900

2776 Cleveland Ave
Fort Myers, FL 33901
Phone (239) 343-2000

8931 Colonial Center Dr
Ste 401
Fort Myers, FL 33905
Phone (239) 424-2030

4751 S Cleveland Ave
Fort Myers, FL 33907
Phone (239) 343-9880

930 S Main St
Ste C
Labelle, FL 33935
Phone (239) 674-5520

260 Beth Stacey Blvd
Ste C
Lehigh Acres, FL 33936

Interoperability endpoints

  • Direct secure messaging: rwiik308257@direct.leememorial.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670457600000",
    "number": "1154058634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2147",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339022147",
            "telephone_number": "239-343-9888",
            "fax_number": "239-303-0714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 BETH STACEY BLVD STE C",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339366074",
            "telephone_number": "239-343-9888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4751 S Cleveland Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339071317",
            "country_code": "US",
            "telephone_number": "239-343-9888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIIK",
        "first_name": "RACHEL",
        "middle_name": "RODRIGO",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-04",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "APRN11012859",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "APRN11012859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115415100",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rwiik308257@Direct.leememorial.org",
            "affiliation": "Y",
            "affiliationName": "Lee Memorial Health System",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2776 Cleveland Ave",
            "city": "Fort Myers",
            "state": "FL",
            "country_code": "US",
            "postal_code": "339015864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lehigh Acres, FL

Sources for this page

Verify at the official NPI Registry.