Healthcare Provider Details

I. General information

NPI: 1376366203
Provider Name (Legal Business Name): TANISHA WORTHY WILLIAMS DNP, MSN, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

1404 DENNIS AVE
SILVER SPRING MD
20902-3828
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-4000
  • Fax:
Mailing address:
  • Phone: 919-475-8766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number202415761
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: