Provider Demographics
NPI:1750770442
Name:WILSON, JENNIE LYNN (ARNP)
Entity type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2919 W SWANN AVE STE 400A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4082
Mailing Address - Country:US
Mailing Address - Phone:813-871-2959
Mailing Address - Fax:813-877-8891
Practice Address - Street 1:2919 W SWANN AVE STE 400A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4082
Practice Address - Country:US
Practice Address - Phone:813-871-2959
Practice Address - Fax:813-877-8891
Is Sole Proprietor?:No
Enumeration Date:2015-01-18
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2881212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily