Provider Demographics
NPI:1295344604
Name:WILLIAMS, PORTIA (APRN)
Entity type:Individual
Prefix:
First Name:PORTIA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PORTIA
Other - Middle Name:
Other - Last Name:BOATWRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2225 SW NEWPORT ISLES BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4575
Mailing Address - Country:US
Mailing Address - Phone:561-633-0104
Mailing Address - Fax:888-411-5724
Practice Address - Street 1:2225 SW NEWPORT ISLES BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-4575
Practice Address - Country:US
Practice Address - Phone:561-633-0104
Practice Address - Fax:888-411-5724
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9322322163WG0000X
FL11010453363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty