Provider Demographics
NPI:1952913485
Name:WILCOCK, TODD JOESPH (FNP)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:JOESPH
Last Name:WILCOCK
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 E 1650 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-2200
Mailing Address - Country:US
Mailing Address - Phone:801-860-3923
Mailing Address - Fax:
Practice Address - Street 1:658 E 1650 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-2200
Practice Address - Country:US
Practice Address - Phone:801-860-3923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6445870-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse