Individual
JAMIE LYNN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
580 W 8TH ST, TOWER 1, 8TH FLOOR, JACKSONVILLE, FL 32209-6533
(904) 244-9052
(904) 244-9437
Mailing address
PO BOX 44008, UFJAX - PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
(904) 244-3199
(904) 244-3425
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9107414
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003140746A
—
GA
05
—
009895800
—
FL
Enumeration date
10/22/2013
Last updated
03/03/2020
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