Provider Demographics
NPI:1760675003
Name:WILLIAMS, SANDRA S (RN BSN PHN CSRN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN BSN PHN CSRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7040 LAKE ELLENOR DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-5750
Mailing Address - Country:US
Mailing Address - Phone:407-858-6143
Mailing Address - Fax:407-856-6594
Practice Address - Street 1:7040 LAKE ELLENOR DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5750
Practice Address - Country:US
Practice Address - Phone:407-858-6143
Practice Address - Fax:407-856-6594
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN962592163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management