MEDICARE: CANDICE MELODY 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
1	363LP0200X	Pediatric Nurse Practitioner	ARNP9327498	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

General Provider Information

NPI Number	:	1609314061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE MELODY WILSON ARNP

Provider Business Mailing Address
First Line	:	63 RILEY RD
Second Line	:
City	:	CELEBRATION
State	:	FL
Zip	:	34747-5419
Country	:	US
Telephone Number	:	407-930-6900
Fax Number	:	321-203-4669

Provider Business Practice Location Address
First Line	:	63 RILEY RD
Second Line	:
City	:	CELEBRATION
State	:	FL
Zip	:	34747-5419
Country	:	US
Telephone Number	:	407-930-6900
Fax Number	:	321-203-4669

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

Provider Enumeration Date	:	02/06/2017
Last Update Date	:	12/26/2023

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