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General NPI Number Information
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NPI Number | 1275820334
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Entity Type | Individual
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Provider Name | SARA A WILSON ARNP
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Gender | Female
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 07/08/2011
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Provider Practice Location Address
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Address Line | 3654 SW 30TH AVE
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City | PALM CITY
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State | FL
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Zip | 34990-3700
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Country | US
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Telephone | 772-403-2227
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Fax |
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Provider Business Mailing Address
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Address Line | 4911 BALD CYPRESS TRL
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City | FORT PIERCE
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State | FL
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Zip | 34951-3528
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Country | US
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Telephone | 772-489-2296
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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 | ARNP9190825
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License Number State | FL
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