Provider Demographics
NPI:1093156309
Name:WILLIAMS, GIA MARIE
Entity Type:Individual
Prefix:MISS
First Name:GIA
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3013
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77305-3013
Mailing Address - Country:US
Mailing Address - Phone:901-275-2895
Mailing Address - Fax:
Practice Address - Street 1:3687 TAMPA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-6307
Practice Address - Country:US
Practice Address - Phone:866-568-9068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily