Individual
DR. CARLENE A. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6038 W NORDLING LOOP, CRYSTAL RIVER, FL 34429
(352) 563-5070
(352) 795-4322
Mailing address
6038 W NORDLING LOOP, CRYSTAL RIVER, FL 34429
(352) 563-5070
(352) 795-4322
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME93743
FL
208000000X
Pediatrics Physician
ME93743
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
271841
—
SC
05
—
273971200
—
FL
01
—
30031
BLUE CROSS OF FLORIDA
FL
05
—
428955383A
—
GA
01
—
5705127861001
BLUE CROSS OF SC
SC
05
—
GP0237
—
SC
Enumeration date
06/09/2005
Last updated
06/09/2014
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