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General NPI Number Information
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NPI Number | 1154188654
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Entity Type | Individual
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Provider Name | KARA WILFONG APRN-FNP
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Gender | Female
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Dates
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Enumeration Date | 03/01/2024
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 1590 ISLAND LN STE 28
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-4409
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Country | US
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Telephone | 904-293-1692
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Fax |
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Provider Business Mailing Address
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Address Line | 116 TAYLOR RD
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City | PALATKA
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State | FL
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Zip | 32177-8155
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11031593
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License Number State | FL
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