Active NPI
Jennifer Wilson
- Registered Nurse
- Tampa, FL
National Provider Identifier
1770012775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN933005
- Practice address
- 3902 Henderson Blvd Ste 202
Tampa, FL 33629-5034 - Phone
- (813) 412-7190
- NPI assigned
- Jun 5, 2017
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN933005 | FL | Primary |
Addresses
Primary practice location
3902 Henderson Blvd Ste 202
Tampa, FL 33629-5034
Mailing address
3902 Henderson Blvd Ste 202
Tampa, FL 33629-5034
Phone (813) 412-7190
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 |
|---|---|---|---|
| RN933005 | FL | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Henry Fate Corporation | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Home Health Agency
- Tampa, FL
- NPI 1942692504
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1770012775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3902 HENDERSON BLVD STE 202",
"city": "TAMPA",
"state": "FL",
"postal_code": "336295034",
"telephone_number": "813-412-7190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3902 HENDERSON BLVD STE 202",
"city": "TAMPA",
"state": "FL",
"postal_code": "336295034",
"telephone_number": "813-412-7190"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JENNIFER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-05",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "FL",
"license": "RN933005",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.