Healthcare Provider Details

I. General information

NPI: 1255884706
Provider Name (Legal Business Name): LATOYA JANELLE WILSON APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36440 US HIGHWAY 19 N
PALM HARBOR FL
34684-1330
US

IV. Provider business mailing address

3251 N MCMULLEN BOOTH RD STE 303
CLEARWATER FL
33761-2022
US

V. Phone/Fax

Practice location:
  • Phone: 727-786-0696
  • Fax: 727-669-9742
Mailing address:
  • Phone: 727-725-6110
  • Fax: 727-669-9742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9309349
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: