Healthcare Provider Details

I. General information

NPI: 1083534382
Provider Name (Legal Business Name): LATASHA K WILLIAMSON AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 WEST DR
VISTA CA
92083-6115
US

IV. Provider business mailing address

4348 RAINIER WAY APT D
OCEANSIDE CA
92058-7936
US

V. Phone/Fax

Practice location:
  • Phone: 619-205-4585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95040523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: