Provider Demographics
NPI:1164192084
Name:WILLIAMS, PRISCILLA THERESA
Entity Type:Individual
Prefix:MISS
First Name:PRISCILLA
Middle Name:THERESA
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 1:4705 28TH CT
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-6233
Mailing Address - Country:US
Mailing Address - Phone:561-667-8908
Mailing Address - Fax:
Practice Address - Street 1:4515 33RD AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-1101
Practice Address - Country:US
Practice Address - Phone:561-667-8908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care