Provider Demographics
NPI:1740487370
Name:WILLIAMS, STACEY ROCHELLE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:ROCHELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
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Mailing Address - Street 1:720 SW 2ND AVE
Mailing Address - Street 2:STE 160A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-1209
Mailing Address - Country:US
Mailing Address - Phone:352-240-8000
Mailing Address - Fax:352-377-6039
Practice Address - Street 1:5300 MILITARY RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1903
Practice Address - Country:US
Practice Address - Phone:716-284-8917
Practice Address - Fax:716-284-0428
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9431415363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily