Provider Demographics
NPI:1851347744
Name:WILSON, PATRICIA ALEXANDER (MSN ARNP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ALEXANDER
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSN ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1295 W FAIRFIELD DR
Mailing Address - Street 2:ATTN SUSIE PITMAN
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-1107
Mailing Address - Country:US
Mailing Address - Phone:850-595-6417
Mailing Address - Fax:850-595-6693
Practice Address - Street 1:1295 W FAIRFIELD DR
Practice Address - Street 2:ATTN: SUSIE PITMAN
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1107
Practice Address - Country:US
Practice Address - Phone:850-595-6417
Practice Address - Fax:850-595-6693
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL157627Z363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3061434-00Medicaid