MEDICARE: CANDY WILSON WHNP-BC

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	163WW0101X	Ambulatory Women's Health Care Registered Nurse	1071693	KY
2	363LW0102X	Women's Health Nurse Practitioner	APRN11021328	FL

General Provider Information

NPI Number	:	1255391322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDY WILSON WHNP-BC

Provider Business Mailing Address
First Line	:	12820 82ND ST N
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33412-2903
Country	:	US
Telephone Number	:	443-975-0940
Fax Number	:

Provider Business Practice Location Address
First Line	:	12820 82ND ST N
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33412-2903
Country	:	US
Telephone Number	:	443-975-0940
Fax Number	:

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	05/04/2023

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