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General NPI Number Information
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NPI Number | 1548887334
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Entity Type | Individual
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Provider Name | IRENE TUNGOL WILKERSON
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Gender | Female
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Dates
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Enumeration Date | 06/29/2020
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 325 NORWOOD ST
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-4764
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Country | US
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Telephone | 321-459-0530
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Fax | 321-459-0530
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Provider Business Mailing Address
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Address Line | 1014 WOODLAWN RD
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City | ROCKLEDGE
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State | FL
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Zip | 32955-2215
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Country | US
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Telephone | 407-715-7845
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Fax | 800-240-2085
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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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL11011
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License Number State | FL
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