Individual
ANNETTE L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
841 PRUDENTIAL DR FL 10, JACKSONVILLE, FL 32207-8329
(904) 398-5404
(904) 391-5545
Mailing address
PO BOX 746649, ATLANTA, GA 30374-6649
(904) 376-4400
(904) 391-5595
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9104317
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
994760364A
—
GA
01
—
PA 9104317
FLORIDA LICENSE
FL
Enumeration date
03/04/2009
Last updated
01/18/2024
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