Healthcare Provider Details

I. General information

NPI: 1710537915
Provider Name (Legal Business Name): DORIT WILSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9732 NW 46TH MNR
CORAL SPRINGS FL
33076-2604
US

IV. Provider business mailing address

9732 NW 46TH MNR
CORAL SPRINGS FL
33076-2604
US

V. Phone/Fax

Practice location:
  • Phone: 954-234-8975
  • Fax:
Mailing address:
  • Phone: 954-295-6782
  • Fax: 954-295-6782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11003462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: