Healthcare Provider Details

I. General information

NPI: 1043874811
Provider Name (Legal Business Name): DONETA WILSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DONETA TODD APRN

II. Dates (important events)

Enumeration Date: 04/27/2019
Last Update Date: 07/11/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N UNIVERSITY DR STE 217
CORAL SPRINGS FL
33071-8933
US

IV. Provider business mailing address

1380 NE MIAMI GARDENS DR STE 210
NORTH MIAMI BEACH FL
33179-4709
US

V. Phone/Fax

Practice location:
  • Phone: 305-931-7424
  • Fax:
Mailing address:
  • Phone: 305-931-7424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number9275062
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11002557
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: