Provider Demographics
NPI:1912431545
Name:WILLIAMS, TYREE SR (RDN, LD/N)
Entity Type:Individual
Prefix:MR
First Name:TYREE
Middle Name:
Last Name:WILLIAMS
Suffix:SR
Gender:M
Credentials:RDN, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10757 MEADOW LEA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4503
Mailing Address - Country:US
Mailing Address - Phone:904-707-0505
Mailing Address - Fax:
Practice Address - Street 1:10757 MEADOW LEA DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4503
Practice Address - Country:US
Practice Address - Phone:904-707-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 6743133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered