Healthcare Provider Details

I. General information

NPI: 1083980437
Provider Name (Legal Business Name): YANNA WILLS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4478 ALLIGATOR FLAG CIR
WEST MELBOURNE FL
32904-8198
US

IV. Provider business mailing address

PO BOX 120026
WEST MELBOURNE FL
32912-0026
US

V. Phone/Fax

Practice location:
  • Phone: 561-898-2337
  • Fax:
Mailing address:
  • Phone: 561-898-2337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11045139
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: