Provider Demographics
NPI:1881829042
Name:WILSON, ALICE M (RNFA)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3436 PRIMROSE WAY
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-2229
Mailing Address - Country:US
Mailing Address - Phone:727-641-7847
Mailing Address - Fax:727-786-4724
Practice Address - Street 1:3436 PRIMROSE WAY
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-2229
Practice Address - Country:US
Practice Address - Phone:727-641-7847
Practice Address - Fax:727-786-4724
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3391562163WR0006X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163W00000XNursing Service ProvidersRegistered Nurse