Healthcare Provider Details

I. General information

NPI: 1811483324
Provider Name (Legal Business Name): ERIC J WILSON ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 01/27/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 W NEWBERRY RD STE 210
GAINESVILLE FL
32605-6602
US

IV. Provider business mailing address

2405 SE 17TH ST STE 201
OCALA FL
34471-9190
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-3583
  • Fax: 352-331-3669
Mailing address:
  • Phone: 352-690-2171
  • Fax: 352-690-6954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9317347
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9317347
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: