Provider Demographics
NPI:1225799018
Name:WILLIS, TAMILA (FNP-C)
Entity Type:Individual
Prefix:
First Name:TAMILA
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-3301
Mailing Address - Country:US
Mailing Address - Phone:928-428-3122
Mailing Address - Fax:928-428-7917
Practice Address - Street 1:1300 S 20TH AVE
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-3301
Practice Address - Country:US
Practice Address - Phone:928-428-3122
Practice Address - Fax:928-428-7917
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN153089163W00000X
AZ270116207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine