Provider Demographics
NPI:1558820241
Name:WILLIAMS, KOMONIQUE (CNA, PHLEBOTOMY)
Entity Type:Individual
Prefix:
First Name:KOMONIQUE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CNA, PHLEBOTOMY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 E MOWRY DR APT 108
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-4957
Mailing Address - Country:US
Mailing Address - Phone:786-414-8909
Mailing Address - Fax:
Practice Address - Street 1:1430 E MOWRY DR APT 108
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-4957
Practice Address - Country:US
Practice Address - Phone:786-414-8909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL286814376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker