=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225429889
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA FRANCESCA ZAMPOGNA WILSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2015
-----------------------------------------------------
Last Update Date | 09/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6400 DAVIS BLVD STE 203
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34104-5321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-775-2300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6400 DAVIS BLVD STE 103
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34104-5321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-775-2300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA 9108480
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------