Provider Demographics
NPI:1184040891
Name:WILLIAMS, SANDRELL (ARNP)
Entity Type:Individual
Prefix:
First Name:SANDRELL
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SANDRELL
Other - Middle Name:
Other - Last Name:LEGGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:4313 S FLORIDA AVE # 1005
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1654
Mailing Address - Country:US
Mailing Address - Phone:863-457-4919
Mailing Address - Fax:
Practice Address - Street 1:6800 N DALE MABRY HWY STE 186
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3998
Practice Address - Country:US
Practice Address - Phone:813-839-3438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9281116363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner