Provider Demographics
NPI:1629441803
Name:WILLIAMS, LAVONIA SHANETTA (BSN, RN)
Entity Type:Individual
Prefix:
First Name:LAVONIA
Middle Name:SHANETTA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10580 NE 77TH PL
Mailing Address - Street 2:
Mailing Address - City:BRONSON
Mailing Address - State:FL
Mailing Address - Zip Code:32621-4646
Mailing Address - Country:US
Mailing Address - Phone:352-328-8738
Mailing Address - Fax:
Practice Address - Street 1:10580 NE 77TH PL
Practice Address - Street 2:
Practice Address - City:BRONSON
Practice Address - State:FL
Practice Address - Zip Code:32621-4646
Practice Address - Country:US
Practice Address - Phone:352-328-8738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9348563163W00000X
FL9348563163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse