MEDICARE: MRS. MARY ANNE EVERTZ WILCOX

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	1041C0700X	Clinical Social Worker	ISW19988	FL

General Provider Information

NPI Number	:	1386408177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ANNE EVERTZ WILCOX

Provider Business Mailing Address
First Line	:	4692 OLD GUERNSEY RD
Second Line	:
City	:	MILTON
State	:	FL
Zip	:	32571-8682
Country	:	US
Telephone Number	:	850-602-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 MIRACLE STRIP PKWY SE
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32548-5819
Country	:	US
Telephone Number	:	850-861-7171
Fax Number	:

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

Provider Enumeration Date	:	02/12/2024
Last Update Date	:	02/27/2024

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