Active NPI
Wilson Fonseca
- Registered Nurse
- Kissimmee, FL
National Provider Identifier
1699145672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 163W0000X
- Practice address
- 4129 Bald Eagle Dr
Kissimmee, FL 34746-2901 - Phone
- (786) 447-4100
- Fax
- (561) 516-6220
- NPI assigned
- Oct 2, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 163W0000X | FL | Primary |
Addresses
Primary practice location
4129 Bald Eagle Dr
Kissimmee, FL 34746-2901
Mailing address
4129 Bald Eagle Dr
Kissimmee, FL 34746-2901
Phone (786) 447-4100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01531100 | Medicaid | FL |
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 |
|---|---|---|---|
| 163W0000X | FL | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443744000000",
"number": "1699145672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4129 BALD EAGLE DR",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "347462901",
"telephone_number": "786-447-4100",
"fax_number": "561-516-6220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4129 BALD EAGLE DR",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "347462901",
"telephone_number": "786-447-4100",
"fax_number": "561-516-6220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONSECA",
"first_name": "WILSON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-10-02",
"last_updated": "2015-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "FL",
"license": "163W0000X",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01531100",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kissimmee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.