Healthcare Provider Details

I. General information

NPI: 1851347744
Provider Name (Legal Business Name): PATRICIA ALEXANDER WILSON MSN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 W FAIRFIELD DR ATTN: SUSIE PITMAN
PENSACOLA FL
32501-1107
US

IV. Provider business mailing address

1295 W FAIRFIELD DR ATTN SUSIE PITMAN
PENSACOLA FL
32501-1107
US

V. Phone/Fax

Practice location:
  • Phone: 850-595-6417
  • Fax: 850-595-6693
Mailing address:
  • Phone: 850-595-6417
  • Fax: 850-595-6693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number157627Z
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: