Provider Demographics
NPI:1871036988
Name:WILLIAMS, TYSNIE (CNA)
Entity Type:Individual
Prefix:
First Name:TYSNIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13104 SANCTUARY COVE DR
Mailing Address - Street 2:UNIT 104
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-2161
Mailing Address - Country:US
Mailing Address - Phone:813-340-0173
Mailing Address - Fax:
Practice Address - Street 1:13104 SANCTUARY COVE DR
Practice Address - Street 2:UNIT 104
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-2161
Practice Address - Country:US
Practice Address - Phone:813-340-0173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X, 372600000X, 376J00000X
FLCNA307360376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker