Provider Demographics
NPI:1639615958
Name:WILLIAMS, GLENDA CAMPBELL (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:CAMPBELL
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2648 FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-3414
Mailing Address - Country:US
Mailing Address - Phone:904-412-4219
Mailing Address - Fax:
Practice Address - Street 1:2648 FOREST BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-3414
Practice Address - Country:US
Practice Address - Phone:904-412-4219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9357836163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse