Emily Willis

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11028516 Issued in FL

Practice address

1825 Salk Ave
Tavares, FL 32778-4311

Phone

(352) 343-1158

Fax

(352) 505-9302

NPI assigned

Sep 11, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Wallace Health, LLC

  • Adult Health Nurse Practitioner
  • Umatilla, FL
  • NPI 1598356289
  Medicare reassignment NPD
• Cardiovascular Institute of Central Florida, LLC

  • Specialist
  • Ocala, FL
  • NPI 1679666598
  NPD (past)
• Central Florida Cardiology & Vascular Center LLC

  • Cardiovascular Disease Physician
  • Tavares, FL
  • NPI 1225332075
  NPD (past)

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

{
    "created_epoch": "1694390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1346027752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 SALK AVE",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327784311",
            "telephone_number": "352-343-1158",
            "fax_number": "352-505-9302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 SALK AVE",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327784311",
            "telephone_number": "352-343-1158",
            "fax_number": "352-505-9302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "EMILY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-11",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11028516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shalese White
• William Middleton, MD, Facs
• Eric Williams, MD
• Gregory Williams
• Lois Jean Williams, LPN
• James L. Willis, D.O.
• Donna L Wittwer
• Bruce Chester Wlosinski, LCSW
• Teddric W. Wolff, CRNA
• Shelagh Kathryn Wood-Gouveia, NP

• Family Nurse Practitioner in Tavares, FL
• Providers in Tavares, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.