Provider Demographics
NPI:1760933766
Name:WILLETT, JOCELYN MOSELLE (ANP)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:MOSELLE
Last Name:WILLETT
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 SE PHILLIPS BEND AVE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-8176
Mailing Address - Country:US
Mailing Address - Phone:716-440-7839
Mailing Address - Fax:
Practice Address - Street 1:6201 SE PHILLIPS BEND AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-8176
Practice Address - Country:US
Practice Address - Phone:716-440-7839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307748363L00000X
FL11011027363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04604202Medicaid