Individual
MRS. CHARLENE A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5955 PONCE DE LEON BLVD, CORAL GABLES, FL 33146-2423
(305) 661-1515
Mailing address
5955 PONCE DE LEON BLVD, CORAL GABLES, FL 33146-2423
(305) 661-1515
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9111001
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA9111001
FLORIDA DEPARTMENT OF HEALTH
FL
Enumeration date
01/23/2018
Last updated
04/03/2018
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