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NPI Code Detail

MEDICARE: MS. HOLLY MARIE WILSON

MEDICARE: MS. HOLLY MARIE WILSON
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
1235Z00000XSpeech-Language PathologistFL

General Provider Information

NPI Number : 1720918386
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. HOLLY MARIE WILSON
Provider Business Mailing Address
First Line : 12276 SAN JOSE BLVD STE 508
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32223-8618
Country : US
Telephone Number : 904-886-3228
Fax Number : 904-485-8876
Provider Business Practice Location Address
First Line : 12276 SAN JOSE BLVD STE 508
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32223-8618
Country : US
Telephone Number : 904-886-3228
Fax Number : 904-485-8876
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2026
Last Update Date : 05/22/2026

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Directions to “ MS. HOLLY MARIE WILSON ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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