Provider Demographics
NPI:1942757943
Name:WILLIS, MORGAN DANIELLE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:DANIELLE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 COSTA MESA
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7849
Mailing Address - Country:US
Mailing Address - Phone:318-376-0694
Mailing Address - Fax:
Practice Address - Street 1:1502 CREIGHTON RD STE C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7143
Practice Address - Country:US
Practice Address - Phone:318-376-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008273367500000X
IN28230131A163W00000X
TX780615163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine