Healthcare Provider Details

I. General information

NPI: 1720123391
Provider Name (Legal Business Name): TODD CHRISTOPHER WILSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 TRANSOM CT
TAMPA FL
33607-5863
US

IV. Provider business mailing address

7520 TRANSOM CT
TAMPA FL
33607-5863
US

V. Phone/Fax

Practice location:
  • Phone: 727-535-1437
  • Fax: 727-535-4190
Mailing address:
  • Phone: 727-535-1437
  • Fax: 727-535-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: