Provider Demographics
NPI:1669714929
Name:WILKINSON, CAROL G (CRNA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:G
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14750 BEACH BLVD APT 56
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2354
Mailing Address - Country:US
Mailing Address - Phone:904-536-7266
Mailing Address - Fax:813-844-4972
Practice Address - Street 1:1564 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4521
Practice Address - Country:US
Practice Address - Phone:904-264-0400
Practice Address - Fax:904-264-0401
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1527642367500000X
GARN228493367500000X
FLAPRN1527642367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010946000Medicaid