Provider Demographics
NPI:1760556112
Name:WILSON, TAMESIA ANNETTE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:TAMESIA
Middle Name:ANNETTE
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 1:103 WARE RHANEY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32307-0001
Mailing Address - Country:US
Mailing Address - Phone:850-599-3017
Mailing Address - Fax:
Practice Address - Street 1:103 WARE RHANEY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32307-0001
Practice Address - Country:US
Practice Address - Phone:850-599-3017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2225182163W00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse