Provider Demographics
NPI:1174971295
Name:WILLIAMS, JENNIFER JUNE
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JUNE
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 1:7575 DR. PHILLIPS BLVD.
Mailing Address - Street 2:SUITE 155
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819
Mailing Address - Country:US
Mailing Address - Phone:407-982-4876
Mailing Address - Fax:407-650-2754
Practice Address - Street 1:7575 DR PHILLIPS BLVD
Practice Address - Street 2:SUITE 155
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7216
Practice Address - Country:US
Practice Address - Phone:407-574-8383
Practice Address - Fax:407-650-2754
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246Z00000X, 174400000X
FL48-44-1429112246Z00000X, 246ZA2600X
FL59-BID-2539293246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48-44-1429112OtherFLORIDA DEPT OF HEALTH