Provider Demographics
NPI:1063943595
Name:WILKINS, HOLLI JO (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:HOLLI
Middle Name:JO
Last Name:WILKINS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:HOLLI
Other - Middle Name:JO
Other - Last Name:KNOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2334 EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3747
Mailing Address - Country:US
Mailing Address - Phone:703-853-8998
Mailing Address - Fax:
Practice Address - Street 1:3020 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-966-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-26
Last Update Date:2017-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95006302363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner