Provider Demographics
NPI:1326597907
Name:WILLIAMS, JUANITA ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:ANN
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 1:4028 SCOTT WOODS DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-6915
Mailing Address - Country:US
Mailing Address - Phone:904-520-8978
Mailing Address - Fax:
Practice Address - Street 1:4028 SCOTT WOODS DR S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-6915
Practice Address - Country:US
Practice Address - Phone:904-520-8978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9371277163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse