Healthcare Provider Details

I. General information

NPI: 1508776451
Provider Name (Legal Business Name): DEONNA G WILLIS APRN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2218 W US HIGHWAY 90 STE 102
LAKE CITY FL
32055-7281
US

IV. Provider business mailing address

2218 W US HIGHWAY 90 STE 102
LAKE CITY FL
32055-7281
US

V. Phone/Fax

Practice location:
  • Phone: 386-243-8991
  • Fax: 386-243-8997
Mailing address:
  • Phone: 386-243-8991
  • Fax: 386-243-8997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DEONNA WILLIS
Title or Position: OWNER
Credential: APRN
Phone: 386-243-8991