Healthcare Provider Details

I. General information

NPI: 1699270520
Provider Name (Legal Business Name): JESSICA GAIL WILSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19527 HIGHLAND OAKS DR STE 201
ESTERO FL
33928-9637
US

IV. Provider business mailing address

19527 HIGHLAND OAKS DR STE 201
ESTERO FL
33928-9637
US

V. Phone/Fax

Practice location:
  • Phone: 239-237-0770
  • Fax:
Mailing address:
  • Phone: 239-237-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number332549
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number20771
License Number StateNH
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME175015
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME175015
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: