Provider Demographics
NPI:1558321893
Name:WILSON, ARLENE MICHELLE (CRNA)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:MICHELLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 W COMMERCIAL BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3392
Mailing Address - Country:US
Mailing Address - Phone:954-485-5666
Mailing Address - Fax:
Practice Address - Street 1:3000 CORAL HILLS DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4108
Practice Address - Country:US
Practice Address - Phone:954-485-5666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2894012367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303809200Medicaid
FL303809200Medicaid
FLG2882ZMedicare ID - Type Unspecified