Individual
KASSI LEE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP-PC
Contact information
Practice address
2 TAMPA GENERAL CIR, TAMPA, FL 33606-3571
(813) 821-8038
(813) 821-8359
Mailing address
2 TAMPA GENERAL CIR OFC 5057, TAMPA, FL 33606-3571
(813) 821-8026
(813) 821-8359
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
APRN11012885
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111087300
—
FL
01
—
8ITXD
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/29/2021
Last updated
09/28/2023
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