Healthcare Provider Details

I. General information

NPI: 1689899981
Provider Name (Legal Business Name): HEATHER LEE WILSON DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5741 BEE RIDGE RD STE 490
SARASOTA FL
34233-5062
US

IV. Provider business mailing address

15815 SHADDOCK DR STE 130
WINTER GARDEN FL
34787-5773
US

V. Phone/Fax

Practice location:
  • Phone: 941-924-8777
  • Fax: 941-924-5888
Mailing address:
  • Phone: 407-605-2321
  • Fax: 407-671-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103300729
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4606
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: