Active NPI
Susan Thompson Wilson, PA-C
- Physician Assistant
- Jacksonville, FL
National Provider Identifier
1336232008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9101471
- Practice address
- 1833 Boulevard
Jacksonville, FL 32206 - Phone
- (904) 232-2751
- Fax
- (904) 301-2502
- NPI assigned
- Oct 2, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9101471 | FL | Primary |
Addresses
Primary practice location
1833 Boulevard
Jacksonville, FL 32206
Mailing address
5220 Ortega Glen Dr.
Jacksonville, FL 32210
Phone (904) 908-0778
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9101471 | FL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1336232008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5220 ORTEGA GLEN DR.",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32210",
"telephone_number": "904-908-0778"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1833 BOULEVARD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32206",
"telephone_number": "904-232-2751",
"fax_number": "904-301-2502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "SUSAN",
"middle_name": "THOMPSON",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9101471",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.