Provider Demographics
NPI:1619075082
Name:WILLIAMS, MARJORIE (NP)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:8390 CHAMPIONS GATE BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CHAMPIONS GATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8310
Mailing Address - Country:US
Mailing Address - Phone:407-390-1677
Mailing Address - Fax:407-390-1765
Practice Address - Street 1:4308 ALTON RD
Practice Address - Street 2:SUITE 950
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4560
Practice Address - Country:US
Practice Address - Phone:305-538-1400
Practice Address - Fax:305-538-6102
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP2856332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAE595ZMedicare PIN