Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | ME122738 | FL |
N | 208200000X | Surgeon | 15759R | LA |
N | 208600000X | Surgeon | 15759R | LA |
Y | 2086S0102X | Surgical Critical Care | ME122738 | FL |
NPI | 1063531804 |
---|---|
Provider Name | Ms. Delinda Demita Wills |
First Address | Daytona Beach, FL 32114-2709 |
Second Address | Daytona Beach, FL 32114-2709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 03/11/2020 |