Individual
MR. STACY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
333 TAMIAMI TRL S STE 101, VENICE, FL 34285-2425
(808) 979-6875
Mailing address
9973 58TH ST E, PARRISH, FL 34219-4443
(808) 979-6875
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
RN9431499
FL
363LA2100X
Acute Care Nurse Practitioner
Primary
APRN-2822
HI
363LA2100X
Acute Care Nurse Practitioner
APRN9431499
FL
Other
Enumeration date
05/15/2018
Last updated
10/14/2021
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