MEDICARE: ROSEMARY T 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	363LF0000X	Family Nurse Practitioner	179451	GA
2	363LF0000X	Family Nurse Practitioner	APRN9220366	FL
3	363L00000X	Nurse Practitioner	APRN9220366	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1306392949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEMARY T WILSON APRN

Provider Business Mailing Address
First Line	:	PO BOX 746636
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6636
Country	:	US
Telephone Number	:	904-202-2092
Fax Number	:	904-376-4075

Provider Business Practice Location Address
First Line	:	1545 S 14TH ST
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-3049
Country	:	US
Telephone Number	:	904-202-4243
Fax Number	:	904-390-7415

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

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	12/09/2025

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Directions to “ ROSEMARY T WILSON APRN” Practice Location

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