Provider Demographics
NPI:1659150449
Name:WILLIAMS, TERESA E
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:E
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12121 FERN HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:GIBSONTON
Mailing Address - State:FL
Mailing Address - Zip Code:33534-5665
Mailing Address - Country:US
Mailing Address - Phone:813-606-0440
Mailing Address - Fax:813-374-7859
Practice Address - Street 1:12121 FERN HAVEN AVE
Practice Address - Street 2:
Practice Address - City:GIBSONTON
Practice Address - State:FL
Practice Address - Zip Code:33534-5665
Practice Address - Country:US
Practice Address - Phone:813-606-0440
Practice Address - Fax:813-374-7859
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL239653376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker