Provider Demographics
NPI:1194418012
Name:WILCOX, MICHELLE (FNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-4994
Mailing Address - Country:US
Mailing Address - Phone:619-841-1310
Mailing Address - Fax:619-841-1311
Practice Address - Street 1:1240 BROADWAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4994
Practice Address - Country:US
Practice Address - Phone:619-841-1310
Practice Address - Fax:619-841-1311
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025923363L00000X
CA762639163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse