Provider Demographics
NPI:1588400857
Name:WILKINSON, TYSHELL N/A (APRN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:TYSHELL
Middle Name:N/A
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7928 ORTEGA BLUFF PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-6266
Mailing Address - Country:US
Mailing Address - Phone:904-802-2714
Mailing Address - Fax:
Practice Address - Street 1:542435 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:CALLAHAN
Practice Address - State:FL
Practice Address - Zip Code:32011-3497
Practice Address - Country:US
Practice Address - Phone:904-507-4623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028991363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily