Provider Demographics
NPI:1669026225
Name:WILLIAMS, URSHALA M
Entity Type:Individual
Prefix:
First Name:URSHALA
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 BARNA AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-2604
Mailing Address - Country:US
Mailing Address - Phone:321-507-6944
Mailing Address - Fax:
Practice Address - Street 1:2005 BARNA AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-2604
Practice Address - Country:US
Practice Address - Phone:321-507-6944
Practice Address - Fax:321-567-2164
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty