Individual provider Active NPI

Whitney Nicole Wilson, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Tallahassee, FL
National Provider Identifier
1528602497
Registry record updated Oct 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APRN11015659 Issued in FL
Practice address
2634 Capital Cir NE BLDG J
Tallahassee, FL 32308-4106
Phone
(850) 523-3333
NPI assigned
Nov 4, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN9350787 FL
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APRN11015659 FL Primary

Addresses

Primary practice location

2634 Capital Cir NE BLDG J
Tallahassee, FL 32308-4106

Mailing address

2634 Capital Cir NE BLDG J
Tallahassee, FL 32308-4106
Phone (850) 523-3333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211030000017 FL Practitioner - Nurse Practitioner 9537557251 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Chrysalis Center, Inc.Group PAC ID 8325186646, 36 clinicians

Practice addresses (Care Compare)

3800 W Broward Blvd
Suite 100
Fort Lauderdale, FL 33312-1018
Phone (954) 587-1008

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN9350787FLMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Chrysalis Center, LLC CurrentSince Nov 1, 2023 Accepting new patients
Florida Therapy Services, Inc PastSince Jul 17, 2021 Accepting new patients

Locations

3800 W Broward Blvd
Ste 100
Ft Lauderdale, FL 33312

2944 Penn Ave
Ste L
Marianna, FL 32448
Phone (850) 526-5500

421 W Oak Ave
Panama City, FL 32401
Phone (850) 215-6007

1713 Mahan Dr
Tallahassee, FL 32308

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634601600000",
    "number": "1528602497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2634 CAPITAL CIR NE BLDG J",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084106",
            "telephone_number": "850-523-3333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2634 CAPITAL CIR NE BLDG J",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084106",
            "telephone_number": "850-523-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "WHITNEY",
        "middle_name": "NICOLE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-04",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "RN9350787",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN11015659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.