Provider Demographics
NPI:1730866393
Name:WILSON, QUIANA JAVA
Entity type:Individual
Prefix:
First Name:QUIANA
Middle Name:JAVA
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 1:2311 ALTERNATE 19N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOUR
Mailing Address - State:FL
Mailing Address - Zip Code:34683
Mailing Address - Country:US
Mailing Address - Phone:813-360-3489
Mailing Address - Fax:
Practice Address - Street 1:135 AARANS POND DR
Practice Address - Street 2:#101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-360-3489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator