Provider Demographics
NPI:1487386884
Name:WILSON, TARASGELA
Entity type:Individual
Prefix:
First Name:TARASGELA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 COCONUT CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33493-2344
Mailing Address - Country:US
Mailing Address - Phone:561-493-4653
Mailing Address - Fax:
Practice Address - Street 1:415 COCONUT CT
Practice Address - Street 2:
Practice Address - City:SOUTH BAY
Practice Address - State:FL
Practice Address - Zip Code:33493-2344
Practice Address - Country:US
Practice Address - Phone:561-493-4653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty