Provider Demographics
NPI:1700438066
Name:WILLIAMS-NOUKHAL, LAKISHA F (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LAKISHA
Middle Name:F
Last Name:WILLIAMS-NOUKHAL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1141
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33575-1141
Mailing Address - Country:US
Mailing Address - Phone:727-644-3191
Mailing Address - Fax:
Practice Address - Street 1:2260 ROANOKE SPRINGS DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-6314
Practice Address - Country:US
Practice Address - Phone:727-644-3191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003056363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11003056Medicaid
FLAPRN11003056OtherMEDICAID