Provider Demographics
NPI:1780945469
Name:WILSON, MARGOT VERONICA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MARGOT
Middle Name:VERONICA
Last Name:WILSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1648 W BLUE HORIZON ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1445
Mailing Address - Country:US
Mailing Address - Phone:757-617-3850
Mailing Address - Fax:520-297-0705
Practice Address - Street 1:1625 W INA RD STE 123
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1975
Practice Address - Country:US
Practice Address - Phone:520-297-9813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170754363L00000X, 363L00000X
AZAP4501364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health