Provider Demographics
NPI:1124359609
Name:WILCOX, KAREN MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MARIE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19105 US HIGHWAY 41N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-5006
Mailing Address - Country:US
Mailing Address - Phone:813-269-2700
Mailing Address - Fax:
Practice Address - Street 1:19105 US HIGHWAY 41N
Practice Address - Street 2:SUITE 100
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-5006
Practice Address - Country:US
Practice Address - Phone:813-269-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9103500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant