Provider Demographics
NPI:1295922763
Name:WILLIAMS, JESSICA IVY (LMT)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:IVY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 MALL DR APT 331
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-5956
Mailing Address - Country:US
Mailing Address - Phone:518-928-3711
Mailing Address - Fax:
Practice Address - Street 1:2750 MALL DR APT 331
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-5956
Practice Address - Country:US
Practice Address - Phone:518-928-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9528327163W00000X
FL49480225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty