Provider Demographics
NPI:1922718386
Name:WILLIAMS, VANESSA RENA
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:RENA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9998 TIMBER FALLS LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-4357
Mailing Address - Country:US
Mailing Address - Phone:904-982-1265
Mailing Address - Fax:
Practice Address - Street 1:9998 TIMBER FALLS LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32219-4357
Practice Address - Country:US
Practice Address - Phone:904-982-1265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL108213374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide