Provider Demographics
NPI:1114072824
Name:WILLIAMS, SUZANNE MICHELE (RN)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MICHELE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10711 MCINTOSH RD
Mailing Address - Street 2:
Mailing Address - City:THONOTOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:33592-3946
Mailing Address - Country:US
Mailing Address - Phone:813-986-6496
Mailing Address - Fax:
Practice Address - Street 1:4100 W KENNEDY BLVD
Practice Address - Street 2:114
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2288
Practice Address - Country:US
Practice Address - Phone:813-639-1915
Practice Address - Fax:813-514-4715
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9230496163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse