Provider Demographics
NPI:1982689386
Name:WILSON, CHRIS LLOYD (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:LLOYD
Last Name:WILSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 862506
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-2506
Mailing Address - Country:US
Mailing Address - Phone:813-985-5992
Mailing Address - Fax:813-985-5982
Practice Address - Street 1:2901 W SWANN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4056
Practice Address - Country:US
Practice Address - Phone:813-985-5992
Practice Address - Fax:813-985-5982
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2637182367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG2044OtherBCBS
FLG2044OtherBCBS