Provider Demographics
NPI:1790083988
Name:WILLIAMS, JOAN Z (RD, LDN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:Z
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 COUNTRYSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3523
Mailing Address - Country:US
Mailing Address - Phone:407-574-2651
Mailing Address - Fax:
Practice Address - Street 1:105 COUNTRYSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-3523
Practice Address - Country:US
Practice Address - Phone:407-574-2651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 3103133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered