Provider Demographics
NPI:1629350160
Name:WILSON, SHERYL ARLYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:ARLYNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5317 S BUDD CT
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-4209
Mailing Address - Country:US
Mailing Address - Phone:215-514-2383
Mailing Address - Fax:
Practice Address - Street 1:1460 BAYTREE DR NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3900
Practice Address - Country:US
Practice Address - Phone:321-914-0915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-11
Last Update Date:2019-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL93000319363LX0001X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology