Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Latasha Wiley

Individual provider Family Nurse Practitioner · NPI 1821628207

Latasha Wiley is a Nurse Practitioner in Jacksonville, Florida. Qualified in 2019, 7 years ago. Practices with Eon Care Clinicians PC, a 24-clinician group and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
7
Licensed in
FL
In the registry since
2020
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Practice location Address checks out

4280 Southside Blvd
Jacksonville, FL 32216-5400
Phone: (904) 998-3677
Fax: (904) 998-4027
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence APRN11005781 (FL)

Record details

NPI number1821628207
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJanuary 24, 2020
Last updated in NPPESJune 22, 2026
Certification dateJune 22, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Eon Care Clinicians Pc — 24 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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