Provider Demographics
NPI:1134221716
Name:WILLIAMS, ANDREA L (APRN)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:699 W COCOA BEACH CSWY
Practice Address - Street 2:SUITE 404
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3577
Practice Address - Country:US
Practice Address - Phone:321-868-2778
Practice Address - Fax:321-868-2748
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3084972363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306312700Medicaid
FLU2614WMedicare PIN