MEDICARE: MS. ALICE M WILSON RNFA

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	163WR0006X	Registered Nurse First Assistant	RN3391562	FL
2	163W00000X	Registered Nurse	RN3391562	FL

General Provider Information

NPI Number	:	1881829042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALICE M WILSON RNFA

Provider Business Mailing Address
First Line	:	3436 PRIMROSE WAY
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-2229
Country	:	US
Telephone Number	:	727-641-7847
Fax Number	:	727-786-4724

Provider Business Practice Location Address
First Line	:	3436 PRIMROSE WAY
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-2229
Country	:	US
Telephone Number	:	727-641-7847
Fax Number	:	727-786-4724

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

Provider Enumeration Date	:	05/18/2009
Last Update Date	:	05/12/2014

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