Provider Demographics
NPI:1871117242
Name:WILSON, CHASSITY ANN (APRN)
Entity type:Individual
Prefix:
First Name:CHASSITY
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 HIGHWAY 20 E STE 108
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439-3912
Mailing Address - Country:US
Mailing Address - Phone:850-880-6433
Mailing Address - Fax:850-807-5145
Practice Address - Street 1:902 HIGHWAY 20 E STE 108
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:FL
Practice Address - Zip Code:32439-3912
Practice Address - Country:US
Practice Address - Phone:850-880-6433
Practice Address - Fax:850-807-5145
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007041363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care