Individual
DOLORES WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3418 HANDY RD, TAMPA, FL 33618-4603
(813) 884-5366
Mailing address
1613 E SITKA ST, TAMPA, FL 33604-3466
(813) 884-5366
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
MA8404
FL
Other
Enumeration date
09/23/2016
Last updated
09/23/2016
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