# JESSICA J WILSON CHAN D O PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457995953
- **Authorized official:** DR. JESSICA JILL WILSON-CHAN DO (PHYSICIAN/OWNER)
- **Authorized official phone:** (813) 586-0618

## Contact information

- **Practice address:** 3284 COVE BEND DR, TAMPA, FL 33613-2752
- **Practice address phone:** (813) 586-0618
- **Practice address fax:** (813) 212-5367
- **Mailing address:** 18002 RICHMOND PLACE DR APT 124, TAMPA, FL 33647-1725
- **Mailing address phone:** (813) 586-0618
- **Mailing address fax:** (813) 212-5367

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/29/2019
- **Last updated:** 09/23/2026