Provider Demographics
NPI:1699241828
Name:WILNER, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:WILNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10761 NW 18TH DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6472
Mailing Address - Country:US
Mailing Address - Phone:954-684-9265
Mailing Address - Fax:
Practice Address - Street 1:1995 E OAKLAND PARK BLVD STE 250
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1149
Practice Address - Country:US
Practice Address - Phone:954-533-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111598363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant