Provider Demographics
NPI:1093174484
Name:WILKINSON, CAROLE L (ARNP, MHPNP)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:L
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:ARNP, MHPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3157 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2258
Mailing Address - Country:US
Mailing Address - Phone:954-849-6027
Mailing Address - Fax:
Practice Address - Street 1:3157 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-2258
Practice Address - Country:US
Practice Address - Phone:954-849-6027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9226404363LP0808X
FLARNP9226404363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1093174484OtherMAGELLAN
FL1093174484OtherTRICARE
FL1093174484OtherAETNA
FL1093174484OtherBLUE CROSS BLUE SHIELD
FL1093174484OtherBAYCARE
FL1093174484OtherCIGNA
FL1093174484OtherBEACON
FL1093174484OtherCOVENTRY
FL1093174484OtherHUMANA
FL1093174484OtherBLUE CROSS
FL1093174484OtherHNITEDHEALTHCARE
FL1093174484OtherMEDICARE
FL1093174484OtherAVMED
FL1093174484OtherBLUE CROSS AND BLUE SCHIELD OF FLORIDA
FL1093174484OtherOPTUM
FL1093174484OtherBUE CROSS BLUE SHIELD