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General NPI Number Information
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NPI Number | 1801302393
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Entity Type | Individual
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Provider Name | KRISTINE ELIZABETH WILSON CRNA, DNP, ARNP
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Gender | Female
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 2001 KINGSLEY AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-5148
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Country | US
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Telephone | 904-639-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 5509 HIGHWAY 17 S
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-4901
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Country | US
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Telephone | 904-449-3289
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ARNP9283814
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | ARNP9283814
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License Number State | FL
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