Provider Demographics
NPI:1902402118
Name:LINDO-WILSON, CAMILLE ANTOINETTE (MSN FNP)
Entity Type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:ANTOINETTE
Last Name:LINDO-WILSON
Suffix:
Gender:F
Credentials:MSN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10895 GREENTRAIL DR S
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-4923
Mailing Address - Country:US
Mailing Address - Phone:404-916-2162
Mailing Address - Fax:
Practice Address - Street 1:10895 GREENTRAIL DR S
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-4923
Practice Address - Country:US
Practice Address - Phone:404-916-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL220192363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner