Individual
MR. BASIL ALEXANDER WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
1801 CRYSTAL LAKE DR, LAKELAND, FL 33801-5979
(863) 937-8886
(863) 937-8892
Mailing address
4863 FOXRUN CIR, LAKELAND, FL 33813-2229
(954) 260-7525
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
ARNP 2068702
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
034712822
ANCC NATIONAL CERT.
FL
05
—
303424100
—
FL
01
—
ARNP 2068702
LICENSE NUMBER
FL
Enumeration date
07/20/2005
Last updated
10/14/2013
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