Provider Demographics
NPI:1801417324
Name:WILLIAMS, LATIENA (DNP)
Entity Type:Individual
Prefix:DR
First Name:LATIENA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 62ND AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-5717
Mailing Address - Country:US
Mailing Address - Phone:727-793-4380
Mailing Address - Fax:
Practice Address - Street 1:715 62ND AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-5717
Practice Address - Country:US
Practice Address - Phone:727-793-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9254707163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse