Provider Demographics
NPI:1922637990
Name:WILLIAMS, TEKEQUA (LPN)
Entity Type:Individual
Prefix:
First Name:TEKEQUA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 COMMONS DR W UNIT 4209
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-8656
Mailing Address - Country:US
Mailing Address - Phone:702-503-2938
Mailing Address - Fax:
Practice Address - Street 1:4320 COMMONS DR W UNIT 4209
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-8656
Practice Address - Country:US
Practice Address - Phone:702-503-2938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV811728164W00000X
FLPN5237841164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse