Provider Demographics
NPI:1891447744
Name:WILLIS-JONES, MASIAI (APRN FNP-C)
Entity Type:Individual
Prefix:
First Name:MASIAI
Middle Name:
Last Name:WILLIS-JONES
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 SW PRATER AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-3844
Mailing Address - Country:US
Mailing Address - Phone:772-278-1031
Mailing Address - Fax:866-765-8608
Practice Address - Street 1:789 SW FEDERAL HWY STE 201
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2962
Practice Address - Country:US
Practice Address - Phone:772-278-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF01220755363LF0000X
FLAPRN11017794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily