Provider Demographics
NPI:1689449985
Name:WILLIAMS, ANTWAIN NICOLANDO
Entity Type:Individual
Prefix:
First Name:ANTWAIN
Middle Name:NICOLANDO
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4802 51ST ST W APT 421
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-5105
Mailing Address - Country:US
Mailing Address - Phone:941-281-6276
Mailing Address - Fax:
Practice Address - Street 1:4802 51ST ST W APT 421
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-5105
Practice Address - Country:US
Practice Address - Phone:941-281-6276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL239722376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker