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General NPI Number Information
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NPI Number | 1407732290
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Entity Type | Individual
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Provider Name | TONYA RENAE WILSON DNP, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 841 JIMMY ANN DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4583
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Country | US
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Telephone | 386-425-3963
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Fax |
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Provider Business Mailing Address
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Address Line | 1244 THOMASINA DR
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City | PORT ORANGE
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State | FL
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Zip | 32129-7437
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Country | US
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Telephone | 386-235-4852
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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 | APRN11040829
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License Number State | FL
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