TACCARA WILLIS (NPI# 1275053662) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275053662 |
| Entity Type | Individual |
| Full Name | TACCARA WILLIS |
| Practice Address |
130 Pablo St Lakeland FL 33803-3818 |
| Mailing Address |
1324 Lakeland Hills Blvd Attn: Managed Care Lakeland FL 33805 |
| Practice Telephone | 8636871100 |
| Mailing Telephone | 8632841611 |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
ARNP9259286 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1324 Lakeland Hills Blvd, Lakeland, FL 338054543 | 8636871321 |
| Street Address |
130 PABLO ST |
| City | LAKELAND |
| State | FL |
| Zip Code | 33803-3818 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003810672 | Andrea Beale | Nurse Practitioner | 130 Pablo St, Lakeland, FL 33803-3818 | 2005-06-10 |
| 1740804673 | Brian Win | Physician Assistant | 130 Pablo St, Lakeland, FL 33803-3818 | 2020-06-06 |
| 1285284216 | Sandra Baffoe-bonnie | Nurse Practitioner | 130 Pablo St, Lakeland, FL 33803-3818 | 2019-09-11 |
| 1215586458 | Jillian Railey | Nurse Practitioner | 130 Pablo St, Lakeland, FL 33803-3818 | 2019-09-10 |
| 1194384362 | Ellen Davis | Physician Assistant | 130 Pablo St, Lakeland, FL 33803-3818 | 2019-06-11 |
| 1558827592 | Rebecca N Levine | Physician Assistant | 130 Pablo St, Lakeland, FL 33803-3818 | 2019-02-14 |
| 1124594007 | Rany Najeh Ahmad | Nurse Practitioner | 130 Pablo St, Lakeland, FL 33803-3818 | 2018-10-18 |
| 1093224206 | Moezza Butler | Registered Nurse | 130 Pablo St, Lakeland, FL 33803-3818 | 2017-09-20 |
| 1679092050 | Jessica Polk | Internal Medicine | 130 Pablo St, Lakeland, FL 33803-3818 | 2017-09-16 |
| 1750803201 | Mary L Roy | Nurse Practitioner | 130 Pablo St, Lakeland, FL 33803-3818 | 2017-07-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861964819 | Steven P Agelidis | Counselor | 2020 S. Florida Ave, Suite 207, Lakeland, FL 33803 | 2018-12-31 |
| 1902316201 | Kesara Mai Ngam | Massage Therapist | 117 West Oak Drive, Lakeland, FL 33803 | 2017-10-02 |
| 1396260618 | Suncoast Behavioral Solutions, LLC | Behavioral Analyst | 1920 E Edgewood Dr Apt A8, Lakeland, FL 33803 | 2017-08-08 |
| 1316484413 | Daniel Jacob Stahl | Behavior Technician | 145 East Edgewood Drive, Lakeland, FL 33803 | 2017-01-26 |
| 1780037002 | Shelley Stettinius | Behavioral Analyst | 145 East Edgewood Dr, Lakeland, FL 33803 | 2016-07-21 |
| 1396106654 | Highlands Occupational Therapy, Inc | Occupational Therapist | 2000 East Edgewood Drive, Suite 114, Lakeland, FL 33803 | 2016-03-15 |
| 1003289570 | Jayna Dinsmore | Physical Therapy Assistant | 321 Imperial Blvd, D38, Lakeland, FL 33803 | 2015-11-05 |
| 1093187429 | Healthstat Wellness Polk-lakeland | Preventive Medicine | 3215 Winter Lake Road, Lakeland, FL 33803 | 2015-10-26 |
| 1962812545 | Florida Presbyterian Homes, Inc | Nursing Facility/Intermediate Care Facility | 901 Lakeside Avenue, Lakeland, FL 33803 | 2014-05-05 |
| 1710316336 | Trinity Endodontics | Health Maintenance Organization | 1602 S. Florida Ave, Ste #1, Lakeland, FL 33803 | 2013-11-04 |
| Find all providers in zip 33803 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417463456 | Jacob Temple | Nurse Practitioner | 3161 Bellflower Way, Lakeland, FL 33811-3033 | 2017-12-27 |
| 1801248281 | Kelly Krieger | Nurse Practitioner | 2000 E Edgewood Dr Ste 112, Lakeland, FL 33803-3639 | 2016-07-08 |
| 1144635780 | Donna Paige Mccraney | Nurse Practitioner | 111 Lake Hollingsworth Drive, Florida Southern College Student Health Center, Lakeland, FL 33801 | 2014-06-23 |
| 1558775411 | Kristen Ley | Nurse Practitioner | 106 W Thigpen Ave, Lakeland, GA 31635-1011 | 2014-06-18 |
| 1902229255 | Christina Miller | Nurse Practitioner | 6850 New Tampa Hwy Ste 600, Lakeland, FL 33815 | 2014-01-22 |
| 1508130071 | Lana Hanscom | Nurse Practitioner | 5108 Lewellyn Rd, Lakeland, FL 33810-0789 | 2012-03-01 |
| 1093340374 | Rashika Battle | Nurse Practitioner | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2020-03-07 |
| 1922642982 | Erika Edwards | Nurse Practitioner | 2417 Us Highway 98 N, Lakeland, FL 33805-2410 | 2019-11-03 |
| 1790248672 | Cristiane Tonia Arboleda | Nurse Practitioner | 2031 E Edgewood Dr Ste 4, Lakeland, FL 33803-3659 | 2019-04-09 |
| 1144789785 | Anielys Salgado | Nurse Practitioner | 3030 Harden Blvd, Lakeland, FL 33803-7952 | 2019-03-13 |
| Find all providers in LAKELAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.