Provider Demographics
NPI:1619517596
Name:WILLIAMS, ASHLEY ANNETTE (RDN/LDN)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ANNETTE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RDN/LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 SE MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-6113
Mailing Address - Country:US
Mailing Address - Phone:719-619-6687
Mailing Address - Fax:
Practice Address - Street 1:3280 SE MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-6113
Practice Address - Country:US
Practice Address - Phone:719-619-6687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND11099133N00000X, 133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education