Healthcare Provider Details

I. General information

NPI: 1144149733
Provider Name (Legal Business Name): HEATHER LYNN WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5473 NEW INDEPENDENCE PKWY
WINTER GARDEN FL
34787-8111
US

IV. Provider business mailing address

5473 NEW INDEPENDENCE PKWY
WINTER GARDEN FL
34787-8111
US

V. Phone/Fax

Practice location:
  • Phone: 407-408-7748
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN9279882
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: