Individual
AMANDA R WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
312 FLINT ST, HAINES CITY, FL 33844-8219
(305) 450-8605
Mailing address
1 SOUTH BLVD E # 2404, DAVENPORT, FL 33837-7547
(305) 450-8605
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
19000304177
FL
Other
Enumeration date
01/03/2020
Last updated
01/03/2020
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