Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APRN11016758 | FL |
NPI | 1033878533 |
---|---|
Provider Name | Dr. Meaghan Wilson |
First Address | Ponte Vedra, FL 32081-8502 |
Second Address | Jacksonville, FL 32207-8207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2021 |
Last Update Date | 19/01/2022 |