MEDICARE: PORTIA WILLIAMS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	9322322	FL
2	363L00000X	Nurse Practitioner	11010453	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295344604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PORTIA WILLIAMS APRN

Provider Business Mailing Address
First Line	:	2225 SW NEWPORT ISLES BLVD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-4575
Country	:	US
Telephone Number	:	561-633-0104
Fax Number	:	888-411-5724

Provider Business Practice Location Address
First Line	:	2225 SW NEWPORT ISLES BLVD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-4575
Country	:	US
Telephone Number	:	561-633-0104
Fax Number	:	888-411-5724

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2020
Last Update Date	:	03/07/2021

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Directions to “ PORTIA WILLIAMS APRN” Practice Location

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