Provider Demographics
NPI:1972673648
Name:WILSON, DANNYLU J (NP)
Entity Type:Individual
Prefix:
First Name:DANNYLU
Middle Name:J
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-7847
Mailing Address - Country:US
Mailing Address - Phone:850-435-7448
Mailing Address - Fax:850-435-3156
Practice Address - Street 1:435 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-7847
Practice Address - Country:US
Practice Address - Phone:850-435-7448
Practice Address - Fax:850-435-3156
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507471Medicaid
TN3732438Medicaid
TN4135398OtherBCBST
4193459OtherBCBS
TN3346726Medicaid
TN3710089Medicaid
TNS66271Medicare UPIN
4193459OtherBCBS
TN1507471Medicaid
TN4135398OtherBCBST
TN3732438Medicaid
33467261Medicare PIN