Provider Demographics
NPI:1043874811
Name:WILSON, DONETA (APRN)
Entity Type:Individual
Prefix:MS
First Name:DONETA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DONETA
Other - Middle Name:
Other - Last Name:TODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1380 NE MIAMI GARDENS DR STE 210
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4709
Mailing Address - Country:US
Mailing Address - Phone:305-931-7424
Mailing Address - Fax:
Practice Address - Street 1:1515 N UNIVERSITY DR STE 217
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8933
Practice Address - Country:US
Practice Address - Phone:305-931-7424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-27
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9275062163WM0705X
FLAPRN11002557363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical