Individual
WILSON FONSECA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4129 BALD EAGLE DR, KISSIMMEE, FL 34746-2901
(786) 447-4100
(561) 516-6220
Mailing address
4129 BALD EAGLE DR, KISSIMMEE, FL 34746-2901
(786) 447-4100
(561) 516-6220
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
163W0000X
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01531100
—
FL
Enumeration date
10/02/2015
Last updated
10/02/2015
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