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General NPI Number Information
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NPI Number | 1437468097
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Entity Type | Individual
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Provider Name | CHRISTINE DEBRA WILSON APRN
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Gender | Female
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 699 W COCOA BEACH CSWY STE 601
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City | COCOA BEACH
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State | FL
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Zip | 32931-3562
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Country | US
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Telephone | 321-868-5833
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Fax | 321-868-5854
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Provider Business Mailing Address
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Address Line | 3300 S FISKE BLVD
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City | ROCKLEDGE
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State | FL
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Zip | 32955-4306
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | ARNP9249801
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License Number State | FL
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