Provider Demographics
NPI:1013272228
Name:LOUIS, WILLINE (APRN, FNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:WILLINE
Middle Name:
Last Name:LOUIS
Suffix:
Gender:F
Credentials:APRN, FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9374 AEGEAN DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-6681
Mailing Address - Country:US
Mailing Address - Phone:954-604-2227
Mailing Address - Fax:866-544-1159
Practice Address - Street 1:980 N FEDERAL HWY STE 110
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-2704
Practice Address - Country:US
Practice Address - Phone:954-604-2227
Practice Address - Fax:866-544-1159
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9202896363L00000X
FLAPRN9202896363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015329100Medicaid