Healthcare Provider Details

I. General information

NPI: 1447454970
Provider Name (Legal Business Name): STEVEN GRANT WILLIS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7544 JACQUE RD
HUDSON FL
34667-7162
US

IV. Provider business mailing address

7544 JACQUE RD
HUDSON FL
34667-7162
US

V. Phone/Fax

Practice location:
  • Phone: 727-372-1005
  • Fax: 727-372-1009
Mailing address:
  • Phone: 727-697-2200
  • Fax: 727-863-8774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 9385
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11023236
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: