Provider Demographics
NPI:1639404601
Name:WILLIAMS, JANE L (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PASADENA AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2128
Mailing Address - Country:US
Mailing Address - Phone:727-345-7100
Mailing Address - Fax:727-345-7102
Practice Address - Street 1:630 PASADENA AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-2128
Practice Address - Country:US
Practice Address - Phone:727-345-7100
Practice Address - Fax:727-345-7102
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105186207Q00000X, 207PE0005X, 207Q00000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002473800Medicaid
FL148YHOtherFLORIDA BLUE
CN073YMedicare PIN