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General NPI Number Information
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NPI Number | 1093259210
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Entity Type | Individual
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Provider Name | HOLLY WILSON APRN
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Gender | Female
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 2112 SUNNYDALE BLVD STE B
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City | CLEARWATER
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State | FL
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Zip | 33765-1207
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Country | US
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Telephone | 727-796-2904
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Fax |
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Provider Business Mailing Address
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Address Line | 2112 SUNNYDALE BLVD STE B
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City | CLEARWATER
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State | FL
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Zip | 33765-1207
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9446932
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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 | APRN11014047
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License Number State | FL
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