MEDICARE: WHITNEY 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	APRN11033903	FL

General Provider Information

NPI Number	:	1790152460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY WILSON APRN

Provider Business Mailing Address
First Line	:	PO BOX 3250
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22604-2450
Country	:	US
Telephone Number	:	540-504-0118
Fax Number	:

Provider Business Practice Location Address
First Line	:	2810 ENTERPRISE RD
Second Line	:
City	:	DEBARY
State	:	FL
Zip	:	32713-2703
Country	:	US
Telephone Number	:	207-775-4000
Fax Number	:

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

Provider Enumeration Date	:	08/28/2015
Last Update Date	:	10/08/2024

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