Provider Demographics
NPI:1700432564
Name:WILSON, MEGAN A (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:A
Last Name:WILSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 VISTAWILLA DR
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-3894
Mailing Address - Country:US
Mailing Address - Phone:407-782-9305
Mailing Address - Fax:
Practice Address - Street 1:696 VISTAWILLA DR
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-3894
Practice Address - Country:US
Practice Address - Phone:407-782-9305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant