Jacqueline Paula Wiesner

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA13010 Issued in FL

Practice address

13180 N Cleveland Ave Ste 117
North Fort Myers, FL 33903-6230

Phone

(239) 218-3764

NPI assigned

Dec 20, 2017

Last updated

Jun 18, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1513728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560816000000",
    "number": "1760998173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4312 S GULF CIR",
            "city": "NORTH FORT MYERS",
            "state": "FL",
            "postal_code": "339035046",
            "telephone_number": "239-218-3764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13180 N CLEVELAND AVE STE 117",
            "city": "NORTH FORT MYERS",
            "state": "FL",
            "postal_code": "339036230",
            "telephone_number": "239-218-3764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESNER",
        "first_name": "JACQUELINE",
        "middle_name": "PAULA",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-20",
        "last_updated": "2019-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "FL",
            "license": "MA13010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "675966100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Welch
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• Nicole Wilson
• Samantha Wolff
• Nina Rae'Chel Woodfield, LM, CPM
• Meghan Nicole Yerian
• Bria Young

• Massage Therapist in North Fort Myers, FL
• Providers in North Fort Myers, FL by specialty
• Massage Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.