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General NPI Number Information
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NPI Number | 1083162846
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Entity Type | Individual
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Provider Name | MICHAEL JEFFREY WILSON A.R.N.P.
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Gender | Male
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 3231 MCMULLEN BOOTH RD FL 1
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City | SAFETY HARBOR
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State | FL
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Zip | 34695-6607
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Country | US
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Telephone | 727-725-6905
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Fax |
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Provider Business Mailing Address
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Address Line | 3231 MCMULLEN BOOTH RD FL 1
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City | SAFETY HARBOR
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State | FL
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Zip | 34695-6607
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Country | US
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Telephone | 727-725-6905
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP9343845
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9343845
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License Number State | FL
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