MEDICARE: MONICA WAID WILSON APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	11008847	FL

General Provider Information

NPI Number	:	1164032959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA WAID WILSON APRN

Provider Business Mailing Address
First Line	:	15390 136TH TER N
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33478-8536
Country	:	US
Telephone Number	:	561-306-8460
Fax Number	:

Provider Business Practice Location Address
First Line	:	2810 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-1538
Country	:	US
Telephone Number	:	561-346-0833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2020
Last Update Date	:	08/07/2024

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