Provider Demographics
NPI:1215095658
Name:WILSON, CHERYL LINN (ARNP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LINN
Last Name:WILSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-528-4975
Mailing Address - Fax:
Practice Address - Street 1:17417 BRIDGE HILL CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3467
Practice Address - Country:US
Practice Address - Phone:813-972-7900
Practice Address - Fax:813-355-5035
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9186217363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01620175OtherFMC-RR MEDICARE
FLY09YWOtherBLUE CROSS BLUE SHIELD
FL004587600Medicaid
FLY09YWOtherBLUE CROSS BLUE SHIELD
FL004587600Medicaid
FLAE011U-FMC-HILLSBOROMedicare PIN