Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | APRN11003630 | FL |
Y | 363LA2200X | Nurse Practitioner - Adult Health | APRN11003630 | FL |
NPI | 1003452418 |
---|---|
Provider Name | Cheza Marie Wilkinson |
First Address | Lakeland, FL 33810-5107 |
Second Address | Lakeland, FL 33810-5107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2019 |
Last Update Date | 30/06/2020 |