Provider Demographics
NPI:1538483417
Name:WILSON, GWENNAELLE ARMELLE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:GWENNAELLE
Middle Name:ARMELLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4033 TAMPA RD
Mailing Address - Street 2:STE. 101
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3224
Mailing Address - Country:US
Mailing Address - Phone:813-854-2003
Mailing Address - Fax:813-855-2367
Practice Address - Street 1:4446 E FLETCHER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4942
Practice Address - Country:US
Practice Address - Phone:813-971-6700
Practice Address - Fax:813-977-1352
Is Sole Proprietor?:No
Enumeration Date:2010-03-20
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 114937208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics