Provider Demographics
NPI:1376207340
Name:WILLIAMS, TARA (DNP, RN)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16000 PINES BLVD UNIT 822701
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33082-9270
Mailing Address - Country:US
Mailing Address - Phone:267-663-8354
Mailing Address - Fax:
Practice Address - Street 1:10360 CITY CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-4488
Practice Address - Country:US
Practice Address - Phone:267-663-8354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9447460163WC0400X, 163WC1500X, 171M00000X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator