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1457613861 NPI number — SOPHIA LORRAINE WILSON FNP

NPI Number: 1457613861
Health Care Provider/Practitioner: SOPHIA LORRAINE WILSON FNP

Information about “1457613861” NPI (SOPHIA LORRAINE WILSON FNP) exists in 1457613861 in HTML format HTML  |  1457613861 in plain Text format TXT  |  1457613861 in PDF (Portable Document Format) PDF  |  1457613861 in an XML format XML  formats.

NPI Number : 1457613861 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457613861",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILSON",
    "FirstName": "SOPHIA",
    "MiddleName": "LORRAINE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "FNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WILSON",
    "OtherFirstName": "SOPHIA",
    "OtherMiddleName": "LORRAINE",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "FNP",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "2950 CLEVELAND CLINIC BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WESTON",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33331-3609",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2950 CLEVELAND CLINIC BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WESTON",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33331-3609",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "954-659-5000",
    "PracticeLocationAddressFaxNumber": "954-659-6789",
    "EnumerationDate": "06/12/2012",
    "LastUpdateDate": "11/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "337155",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "APRN9334166",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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