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NPI Code Detail

MEDICARE: MS. NANNETTE G WILSON ARNP

MEDICARE: MS. NANNETTE G WILSON ARNP
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
1363LA2200XAdult Health Nurse Practitioner1520302FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164609350
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NANNETTE G WILSON ARNP
Provider Business Mailing Address
First Line : 1200 EDGEWATER DR
Second Line :
City : ORLANDO
State : FL
Zip : 32804-6314
Country : US
Telephone Number : 407-244-8559
Fax Number : 407-218-4563
Provider Business Practice Location Address
First Line : 1200 EDGEWATER DR
Second Line :
City : ORLANDO
State : FL
Zip : 32804-6314
Country : US
Telephone Number : 407-244-8559
Fax Number : 407-218-4563
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2008
Last Update Date : 06/14/2013

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