Provider Demographics
NPI:1184872103
Name:WILSON, LEAH PRICE (ARNP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:PRICE
Last Name:WILSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:E
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:435 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-7847
Mailing Address - Country:US
Mailing Address - Phone:850-435-7448
Mailing Address - Fax:850-435-3156
Practice Address - Street 1:435 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-7847
Practice Address - Country:US
Practice Address - Phone:850-435-7448
Practice Address - Fax:850-435-3156
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9250146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL592-06467OtherBLUE CROSS BLUE SHIELD
FL000434600Medicaid
FLY01Q9OtherBLUE CROSS BLUE SHIELD
AL592-06487OtherBLUE CROSS BLUE SHIELD
AL592-06464OtherBLUE CROSS BLUE SHIELD
P00846800OtherMEDICARE RAILROAD
FL000434600Medicaid