Individual
NICOLE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
416 N FERNCREEK AVE STE A, ORLANDO, FL 32803-5432
(407) 898-7798
Mailing address
12380 SHADY SPRING WAY, ORLANDO, FL 32828-9174
(941) 374-1240
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
08/28/2007
Last updated
08/28/2007
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