Individual
LUEQUAYN TAE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE
Contact information
Practice address
3001 ALOMA AVE # 219, WINTER PARK, FL 32792-3752
(407) 497-7409
Mailing address
3001 ALOMA AVE # 219, WINTER PARK, FL 32792-3752
(407) 497-7409
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2017051710580007
—
FL
Enumeration date
05/17/2017
Last updated
07/21/2022
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