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General NPI Number Information
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NPI Number | 1881968840
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Entity Type | Individual
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Provider Name | VICTORIA E WILSON
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Gender | Female
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Dates
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Enumeration Date | 03/08/2012
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 2900 N MILITARY TRL STE 241
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City | BOCA RATON
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State | FL
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Zip | 33431-6347
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Country | US
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Telephone | 561-235-7666
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Fax | 561-948-0989
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Provider Business Mailing Address
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Address Line | 5030 CHAMPION BLVD STE G11-535
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City | BOCA RATON
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State | FL
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Zip | 33496-2473
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Country | US
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Telephone | 561-235-7666
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Fax | 561-948-0989
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9106455
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License Number State | FL
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