MEDICARE: MR. BASIL ALEXANDER WILSON ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP 2068702	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	034712822	OTHER	FL	ANCC NATIONAL CERT.
3	ARNP 2068702	OTHER	FL	LICENSE NUMBER

General Provider Information

NPI Number	:	1447259569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BASIL ALEXANDER WILSON ARNP

Provider Business Mailing Address
First Line	:	4863 FOXRUN CIR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-2229
Country	:	US
Telephone Number	:	954-260-7525
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 CRYSTAL LAKE DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-5979
Country	:	US
Telephone Number	:	863-937-8886
Fax Number	:	863-937-8892

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	10/14/2013

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