Provider Demographics
NPI:1891106969
Name:WILLIAMS, FELISHA L (HOME HEALTH PROVIDER)
Entity Type:Individual
Prefix:
First Name:FELISHA
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:HOME HEALTH PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2367 NW 99TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-2149
Mailing Address - Country:US
Mailing Address - Phone:305-748-8533
Mailing Address - Fax:
Practice Address - Street 1:2367 NW 99TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-2149
Practice Address - Country:US
Practice Address - Phone:305-748-8533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL172A00000X172A00000X
FL172V00000X172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No172A00000XOther Service ProvidersDriver