Provider Demographics
NPI:1396401238
Name:WILLIAMS, TENNILLE (FNP)
Entity Type:Individual
Prefix:
First Name:TENNILLE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TENNILLE
Other - Middle Name:
Other - Last Name:SIMMS-ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:917 E 224TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4603
Mailing Address - Country:US
Mailing Address - Phone:646-441-1817
Mailing Address - Fax:
Practice Address - Street 1:4334A WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-3098
Practice Address - Country:US
Practice Address - Phone:718-231-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily