Christine Elaine Willis, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9108176 Issued in FL

Practice address

1162 Cypress Glen Cir
Kissimmee, FL 34741-7560

Phone

(407) 343-9006

Fax

(407) 343-0999

NPI assigned

Oct 29, 2014

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

Other names 1

• Christine Elaine Gonel Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: cwillis76934@direct.nemours.org

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.

• The Nemours Foundation

  • Multi-Specialty Clinic/Center
  • Jacksonville, FL
  • NPI 1265585806
  NPD (past)

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

{
    "created_epoch": "1414540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414540800000",
    "number": "1902201171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1162 CYPRESS GLEN CIR",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347417560",
            "telephone_number": "407-343-9006",
            "fax_number": "407-343-0999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1162 CYPRESS GLEN CIR",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347417560",
            "telephone_number": "407-343-9006",
            "fax_number": "407-343-0999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "CHRISTINE",
        "middle_name": "ELAINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-29",
        "last_updated": "2014-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9108176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTINE",
            "last_name": "GONEL",
            "middle_name": "ELAINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Racquel Williams
• Taylor Williams, BS, ATC
• Tresha Elizabeth Williams, AGACNP-BC
• Tyyonna Williams, NURSE
• Catherine Willis, APRN
• Arien Dana Wilson
• Destiny Wilson
• Eric Christopher Wilson, MD
• Iris M Wilson, MD
• Matthew Wilson, PHARM.D.

• Medical Physician Assistant in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.