Provider Demographics
NPI:1437791217
Name:WILSON, TAYLOR JOSHUA (PA-C)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JOSHUA
Last Name:WILSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 W MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-9341
Mailing Address - Country:US
Mailing Address - Phone:208-346-2207
Mailing Address - Fax:
Practice Address - Street 1:1425 S US 301
Practice Address - Street 2:
Practice Address - City:SUMTERVILLE
Practice Address - State:FL
Practice Address - Zip Code:33585-5141
Practice Address - Country:US
Practice Address - Phone:352-793-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-12
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant