1164504734 NPI number — MRS. SHERRY DENISE WILLIAMS ARNP

Table of content: MRS. SHERRY DENISE WILLIAMS ARNP (NPI 1164504734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164504734 NPI number — MRS. SHERRY DENISE WILLIAMS ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
SHERRY
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
SHERRY
Provider Other Middle Name:
DENISE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1164504734
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12216 LANGSHAW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THONOTOSASSA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33592-2732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-972-2000
Provider Business Mailing Address Fax Number:
812-910-4022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12216 LANGSHAW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THONOTOSASSA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33592-2732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-972-2000
Provider Business Practice Location Address Fax Number:
812-910-4022
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  ARNP2164002 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 114844000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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