Individual provider Active NPI

Jessica Willis, CRNA

  • Certified Registered Nurse Anesthetist
  • Sanford, FL
National Provider Identifier
1104275874
Registry record updated Dec 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
ARNP9305358 Issued in FL
Practice address
108 Temple Dr
Sanford, FL 32771
Phone
(407) 314-6999
NPI assigned
Jun 3, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X ARNP9305358 FL Primary

Addresses

Primary practice location

108 Temple Dr
Sanford, FL 32771

Mailing address

108 Temple Dr
Sanford, FL 32771
Phone (407) 314-6999

Other practice location 1

52 Underwood St
Orlando, FL 32806-1110
Phone (407) 527-7429

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160810000722 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 6406140730 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Villages Regional Hospital Physician Services LLCGroup PAC ID 0244688893, 198 clinicians
Florida Hospital Healthcare Partners, IncGroup PAC ID 7012266836, 621 clinicians
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

10435 SE 170TH PL
Summerfield, FL 34491-8998
Phone (352) 255-3615

301 Memorial Medical Pkwy
Daytona Beach, FL 32117-5167
Phone (386) 231-6000

380 Rinehart Rd
Lake Mary, FL 32746-2551
Phone (954) 939-5000

52 W Underwood St
Orlando, FL 32806-1110
Phone (407) 841-5111

600 E Dixie Ave
Leesburg, FL 34748-5925

83 W Miller St
Orlando, FL 32806-2031
Phone (954) 939-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
47.54 of 100Reported as apm
Quality
38.49
Promoting interoperability
0
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
ARNP9305358FLMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Villages Regional Hospital Physician Services LLC CurrentSince Jan 1, 2024 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Dec 16, 2024 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Dec 16, 2024 Accepting new patients
Florida Hospital Healthcare Partners, Inc CurrentSince Dec 9, 2025 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Dec 28, 2021 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Dec 28, 2021 Accepting new patients
Anesthesiologists of Greater Orlando Inc Nurse Anesthetist, Certified Registered CurrentSince May 1, 2022 Accepting new patients

Locations

1900 Don Wickham Dr
Clermont, FL 34711
Phone (352) 536-8761

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

301 Memorial Medical Pkwy
Holly Hill, FL 32117
Phone (386) 231-3906

380 Rinehart Rd
Lake Mary, FL 32746
Phone (321) 842-0550

600 E Dixie Ave
Leesburg, FL 34748
Phone (352) 323-5090

555 W State Road 434
Longwood, FL 32750
Phone (407) 767-1200

1055 Saxon Blvd
Orange City, FL 32763
Phone (386) 917-5000

9400 Turkey Lake Rd
Orlando, FL 32819
Phone (321) 843-5500

83 W Miller St
Orlando, FL 32806
Phone (321) 841-5281

52 Underwood St
Orlando, FL 32806
Phone (321) 841-3581

22 Underwood St
Orlando, FL 32806
Phone (321) 841-6263

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

60 Memorial Medical Pkwy
Palm Coast, FL 32164
Phone (385) 586-2000

10435 SE 170th Pl
Summerfield, FL 34491
Phone (352) 245-7788

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: jwillis550355@direct.shands.ufl.edu

Organizations & group practices 9

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734652800000",
    "number": "1104275874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 TEMPLE DR",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "32771",
            "telephone_number": "407-314-6999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 TEMPLE DR",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "32771",
            "telephone_number": "407-314-6999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "52 Underwood St",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328061110",
            "country_code": "US",
            "telephone_number": "407-527-7429",
            "fax_number": "321-843-2196",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JESSICA",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-03",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "ARNP9305358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sanford, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.