Individual
JILL E WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1000 W MORENO ST, PENSACOLA, FL 32501-2316
(850) 437-8390
(850) 437-8394
Mailing address
PO BOX 10824, BIRMINGHAM, AL 35202-0824
(205) 322-1808
(205) 322-1851
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP1934092
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59170259
BCBS
AL
01
—
59170260
BCBS
AL
01
—
G0594
BCBS
FL
01
—
P00134540
PALMETTO GBA-RR MEDICARE
—
Enumeration date
06/12/2006
Last updated
07/08/2007
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