Healthcare Provider Details

I. General information

NPI: 1902234461
Provider Name (Legal Business Name): TRISHA ANN WILLIAMS RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2013
Last Update Date: 12/15/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNER OF ROUTE N12 AND N7
FORT DEFIANCE AZ
86504-0649
US

IV. Provider business mailing address

1568 NW 15TH TER
FT LAUDERDALE FL
33311-5355
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-8132
  • Fax:
Mailing address:
  • Phone: 954-225-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberRTL.0007408
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberRT17305
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: