Provider Demographics
NPI:1922683622
Name:WILSON, DANIELLE J (APRN, FNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:J
Last Name:WILSON
Suffix:
Gender:F
Credentials:APRN, FNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12160 LILY MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5530
Mailing Address - Country:US
Mailing Address - Phone:813-861-5076
Mailing Address - Fax:
Practice Address - Street 1:6101 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3900
Practice Address - Country:US
Practice Address - Phone:239-610-0194
Practice Address - Fax:855-691-0391
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-14
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012118363LP0808X
TX1090199363L00000X
CANP95019735363LF0000X, 363LF0000X
AZCNP278448363LP0808X
NJ26NJ01466600363LP0808X
AZRNP278448363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty