Healthcare Provider Details

I. General information

NPI: 1871902130
Provider Name (Legal Business Name): TANIKA WILLIAMS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 OAKFIELD DR STE 201A
BRANDON FL
33511-4925
US

IV. Provider business mailing address

4310 METRO PKWY STE 205
FORT MYERS FL
33916-9416
US

V. Phone/Fax

Practice location:
  • Phone: 813-655-6367
  • Fax:
Mailing address:
  • Phone: 392-223-2751
  • Fax: 239-561-2933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9389538
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9389538
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0001339952
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: