Provider Demographics
NPI:1891219119
Name:GITTENS-WILLIAMS, WAVENEY (CEO/ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:WAVENEY
Middle Name:
Last Name:GITTENS-WILLIAMS
Suffix:
Gender:F
Credentials:CEO/ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 W IDLEWILD CIR APT 203
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5754
Mailing Address - Country:US
Mailing Address - Phone:813-446-0162
Mailing Address - Fax:813-348-2993
Practice Address - Street 1:3706 W. IDLE WILD CIR #203
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614
Practice Address - Country:US
Practice Address - Phone:813-446-0162
Practice Address - Fax:813-348-2993
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL311500000X
FL234950376J00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No376J00000XNursing Service Related ProvidersHomemaker