Basic Information
| Provider Information | |||||||||
| NPI: | 1063531804 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLS | ||||||||
| FirstName: | DELINDA | ||||||||
| MiddleName: | DEMITA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 N CLYDE MORRIS BLVD | ||||||||
| Address2: | 10E PBFS DEPT | ||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321142709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862264590 | ||||||||
| FaxNumber: | 3862263371 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 N CLYDE MORRIS BLVD. | ||||||||
| Address2: | HALIFAX HEALTH MEDICAL CENTER | ||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321142709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862544152 | ||||||||
| FaxNumber: | 3862544315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 11/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | ME122738 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 208600000X | 15759R | LA | N | Allopathic & Osteopathic Physicians | Surgery | 282NC0060X | 122738 | FL | N | Hospitals | General Acute Care Hospital | Critical Access | 2086S0102X | ME122738 | FL | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
No ID Information.