Healthcare Provider Details

I. General information

NPI: 1154686657
Provider Name (Legal Business Name): JENNIFER MARIE WILSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 S PINE AVE STE 101
OCALA FL
34471-6524
US

IV. Provider business mailing address

1219 S PINE AVE STE 101
OCALA FL
34471-6524
US

V. Phone/Fax

Practice location:
  • Phone: 352-368-2238
  • Fax:
Mailing address:
  • Phone: 352-368-2238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDR.0056560
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301100484
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME182417
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: