Active NPI
Deonna G Willis, APRN
- Family Nurse Practitioner
- Lake City, FL
National Provider Identifier
1972186880
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- APRN11012889
- Practice address
- 404 NW Hall of Fame Dr
Lake City, FL 32055-4833 - Phone
- (386) 719-2540
- NPI assigned
- Apr 29, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | APRN11012889 | FL | Primary |
Addresses
Primary practice location
404 NW Hall of Fame Dr
Lake City, FL 32055-4833
Mailing address
404 NW Hall of Fame Dr
Lake City, FL 32055-4833
Phone (386) 719-2540
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Apr 1, 2023 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638316800000",
"number": "1972186880",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "404 NW HALL OF FAME DR",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "320554833",
"telephone_number": "386-719-2540",
"fax_number": "386-752-9073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 NW HALL OF FAME DR",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "320554833",
"telephone_number": "386-719-2540"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "DEONNA",
"middle_name": "G",
"name_prefix": "Mrs.",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-29",
"last_updated": "2021-12-01",
"certification_date": "2021-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "FL",
"license": "APRN11012889",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.