Provider Demographics
NPI:1588043228
Name:WILLIAMS, KIM SUSAN (APRN)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:SUSAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 S KIRKMAN RD STE 310
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7937
Mailing Address - Country:US
Mailing Address - Phone:407-759-3311
Mailing Address - Fax:407-602-0894
Practice Address - Street 1:5401 S KIRKMAN RD STE 310
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7937
Practice Address - Country:US
Practice Address - Phone:407-759-3311
Practice Address - Fax:407-602-0894
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2021-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3180052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL363LF0000XOtherMEDICAID AND MEDICARE
FL363LF0000XOtherMEDICAID AND MEDICARE