Provider Demographics
NPI:1306390414
Name:WILLIAMS, TASHIBA Q (NP)
Entity Type:Individual
Prefix:
First Name:TASHIBA
Middle Name:Q
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8635 LONG POINT RD STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-3037
Mailing Address - Country:US
Mailing Address - Phone:713-973-8292
Mailing Address - Fax:713-973-0841
Practice Address - Street 1:8635 LONG POINT RD STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-3037
Practice Address - Country:US
Practice Address - Phone:713-973-8292
Practice Address - Fax:713-973-0841
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2019-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX865717363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1306390414Medicaid