Healthcare Provider Details

I. General information

NPI: 1063943595
Provider Name (Legal Business Name): HOLLI JO WILKINS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLI JO KNOX

II. Dates (important events)

Enumeration Date: 03/26/2017
Last Update Date: 03/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

2334 EMERALD ST
SAN DIEGO CA
92109-3747
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-5855
  • Fax:
Mailing address:
  • Phone: 703-853-8998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95006302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: