Provider Demographics
NPI:1912925538
Name:WILCOX, ERIC RAYMOND (PA)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:RAYMOND
Last Name:WILCOX
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-259-0926
Mailing Address - Fax:855-253-4836
Practice Address - Street 1:4446 E FLETCHER AVE STE D
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4942
Practice Address - Country:US
Practice Address - Phone:813-972-2974
Practice Address - Fax:813-866-7227
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103501363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant