Provider Demographics
NPI:1588870620
Name:WILSON, SANDY DENISE (DNP-C)
Entity type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:DENISE
Last Name:WILSON
Suffix:
Gender:F
Credentials:DNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9208 KING PALM DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-1328
Mailing Address - Country:US
Mailing Address - Phone:813-827-9750
Mailing Address - Fax:813-827-1992
Practice Address - Street 1:9208 KING PALM DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-1328
Practice Address - Country:US
Practice Address - Phone:813-827-9750
Practice Address - Fax:813-827-1992
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363L00000X363LF0000X
TNAPN0000011674363LF0000X
TN11674363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily