Mrs. Melania J Willis
Nurse Practitioner - Pediatrics
701 Ohio Ave S
Live Oak
, Florida 32064-3816
Mrs. Melania J Willis
Nurse Practitioner - Pediatrics
701 Ohio Ave S
Live Oak
, Florida 32064-3816
(904) 259-9257
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About
Features
Specialties
- Nurse Practitioner - Pediatrics
Languages spoken
- English
Location
First Address
- Mrs. Melania J Willis
- 7500 S County Road 125
- Macclenny, FL
- Zip : 32063-5328
- Phone : (904) 259-9257
Second Address
- Mrs. Melania J Willis
- 701 Ohio Ave S
- Live Oak, FL
- Zip : 32064-3816
- Fax : (386) 208-1380
- Phone : (386) 330-5248
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LP0200X | Nurse Practitioner - Pediatrics | 2734962 | FL |
National Provider Identifier
| NPI | 1013927995 |
|---|---|
| Provider Name | Mrs. Melania J Willis |
| First Address | Macclenny, FL 32063-5328 |
| Second Address | Live Oak, FL 32064-3816 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 09/08/2006 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| P76481 | (02) | FL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.