Healthcare Provider Details

I. General information

NPI: 1003253857
Provider Name (Legal Business Name): ERICA RENE WILT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA RENE WILT M.D.

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11215 METRO PKWY STE 100
FORT MYERS FL
33966-1206
US

IV. Provider business mailing address

624 QUAKER LN STE D201
HIGH POINT NC
27262-3832
US

V. Phone/Fax

Practice location:
  • Phone: 239-208-2206
  • Fax:
Mailing address:
  • Phone: 336-781-4065
  • Fax: 336-716-3202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number2017-01913
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberU9107
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2024010304
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35.150808
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD220714
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD61551018
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number98605
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME166086
License Number StateFL
# 9
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME166086
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: