Provider Demographics
NPI:1346567203
Name:WILCOX, JOANNE MARIE (PA)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:MARIE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 E OLNEY AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2421
Mailing Address - Country:US
Mailing Address - Phone:215-456-7000
Mailing Address - Fax:215-254-2599
Practice Address - Street 1:800 N JUSTICE ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3410
Practice Address - Country:US
Practice Address - Phone:828-696-1000
Practice Address - Fax:828-696-1314
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA053924363A00000X
NC0010-04816363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCJ595BOtherMEDICARE PTAN
NCP01521620OtherRR MEDICARE
NCP01521620OtherRR MEDICARE