Individual
CAROL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2530 SW SALZEDO AVE, PORT SAINT LUCIE, FL 34987-2244
(772) 340-1972
Mailing address
2530 SW SALZEDO AVE, PORT SAINT LUCIE, FL 34987-2244
(772) 340-1972
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
363LF0000X
FL
Other
Enumeration date
02/22/2016
Last updated
02/22/2016
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