Individual
GLORIA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6943 LUCKY DR E, JACKSONVILLE, FL 32208-4187
(904) 428-2930
(904) 586-2044
Mailing address
6943 LUCKY DR E, JACKSONVILLE, FL 32208-4187
(904) 428-2930
(904) 586-2044
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
NA
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
FL
Enumeration date
09/16/2021
Last updated
09/16/2021
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