Provider Demographics
NPI:1447454970
Name:WILLIS, STEVEN GRANT (APRN)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GRANT
Last Name:WILLIS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7544 JACQUE RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7162
Mailing Address - Country:US
Mailing Address - Phone:727-697-2200
Mailing Address - Fax:727-863-8774
Practice Address - Street 1:7544 JACQUE RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7162
Practice Address - Country:US
Practice Address - Phone:727-372-1005
Practice Address - Fax:727-372-1009
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9385111N00000X
FLAPRN11023236363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2200LOtherBCBS
FL001841600Medicaid
FL001841600Medicaid