Individual
TARASGELA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
415 COCONUT CT, SOUTH BAY, FL 33493-2344
(561) 493-4653
Mailing address
415 COCONUT CT, SOUTH BAY, FL 33493-2344
(561) 493-4653
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
06/26/2022
Last updated
06/26/2022
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