Provider Demographics
NPI:1821314634
Name:WILLIAMS, FREDERIC LEE (ARNP)
Entity Type:Individual
Prefix:
First Name:FREDERIC
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 KINGSLEY AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5174
Mailing Address - Country:US
Mailing Address - Phone:904-276-5400
Mailing Address - Fax:904-276-5430
Practice Address - Street 1:2021 KINGSLEY AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5174
Practice Address - Country:US
Practice Address - Phone:904-276-5400
Practice Address - Fax:904-276-5430
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3283342367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered