Provider Demographics
NPI:1821646431
Name:WILLIAMS, RENA GENTLE HOPE (FNP)
Entity Type:Individual
Prefix:MS
First Name:RENA GENTLE
Middle Name:HOPE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:RENA
Other - Middle Name:GENTLE HOPE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5670 54TH AVE N STE A-1
Mailing Address - Street 2:
Mailing Address - City:KENNETH CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2067
Mailing Address - Country:US
Mailing Address - Phone:727-491-5117
Mailing Address - Fax:
Practice Address - Street 1:5670 54TH AVE N STE A-1
Practice Address - Street 2:
Practice Address - City:KENNETH CITY
Practice Address - State:FL
Practice Address - Zip Code:33709-2067
Practice Address - Country:US
Practice Address - Phone:727-491-5117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003062363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner