Provider Demographics
NPI:1528602497
Name:WILSON, WHITNEY NICOLE (APRN)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:NICOLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 CAPITAL CIR NE BLDG J
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4106
Mailing Address - Country:US
Mailing Address - Phone:850-523-3333
Mailing Address - Fax:
Practice Address - Street 1:2634 CAPITAL CIR NE BLDG J
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4106
Practice Address - Country:US
Practice Address - Phone:850-523-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9350787163W00000X
FLAPRN11015659363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse