Healthcare Provider Details

I. General information

NPI: 1669714929
Provider Name (Legal Business Name): CAROL G WILKINSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1564 KINGSLEY AVE
ORANGE PARK FL
32073-4521
US

IV. Provider business mailing address

14750 BEACH BLVD APT 56
JACKSONVILLE FL
32250-2354
US

V. Phone/Fax

Practice location:
  • Phone: 904-264-0400
  • Fax: 904-264-0401
Mailing address:
  • Phone: 904-536-7266
  • Fax: 813-844-4972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1527642
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN228493
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN1527642
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: