Individual
TIFFANY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
41680 MISS BESSIE DR, LEONARDTOWN, MD 20650-2906
(301) 997-0055
Mailing address
41680 MISS BESSIE DR STE 301, LEONARDTOWN, MD 20650-2965
(301) 997-0055
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN1041996
DC
163W00000X
Registered Nurse
RR223215
MD
363LF0000X
Family Nurse Practitioner
Primary
R223215
MD
Other
Enumeration date
01/10/2019
Last updated
10/01/2019
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