Individual
MARKETA M WILLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4202 E FOWLER AVE, TAMPA, FL 33620-3318
(813) 974-2201
(813) 974-4325
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 974-2201
(813) 974-2812
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME129460
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105267800
—
FL
05
—
2705997
—
OH
01
—
L4530
MEDICARE
FL
01
—
ZZF9W
BLUE CROSS BLUE SHIELD
FL
Enumeration date
12/27/2006
Last updated
10/29/2020
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