Individual
JOSEPH DOMINIC WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
10974 54TH AVE N, ST PETERSBURG, FL 33708-2943
(727) 579-4124
Mailing address
10974 54TH AVE N, ST PETERSBURG, FL 33708-2943
(727) 579-4124
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP1759342
FL
Other
Enumeration date
08/21/2006
Last updated
02/13/2017
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