Provider Demographics
NPI:1750631305
Name:WILLIMS, TERRI (CPM, LM)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:WILLIMS
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6218 ROYAL OAK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-5873
Mailing Address - Country:US
Mailing Address - Phone:321-604-6503
Mailing Address - Fax:
Practice Address - Street 1:6218 ROYAL OAK DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5873
Practice Address - Country:US
Practice Address - Phone:321-604-6503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW265176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife