Provider Demographics
NPI:1285963439
Name:WILSON, JENNIFER ZELVIS (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ZELVIS
Last Name:WILSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ZELVIS
Other - Last Name:ASHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1324 LAKELAND HILLS BLVD
Mailing Address - Street 2:MANAGED CARE DEPT
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1324 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4543
Practice Address - Country:US
Practice Address - Phone:863-687-1321
Practice Address - Fax:863-603-6534
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113052207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006232500Medicaid
FLGG667ZYMedicare PIN