Individual
CHRISTINE DEBRA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
699 W COCOA BEACH CSWY STE 601, COCOA BEACH, FL 32931-3562
(321) 868-5833
(321) 868-5854
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
ARNP9249801
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014571800
—
FL
01
—
DX159X
MEDICARE
FL
Enumeration date
09/30/2010
Last updated
03/16/2020
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