Healthcare Provider Details

I. General information

NPI: 1801484225
Provider Name (Legal Business Name): TAKIARA RENEE SMITH-WILLIAMS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2021
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 LEWIS DR
DAYTONA BEACH FL
32117-4518
US

IV. Provider business mailing address

19 REIDSVILLE DR
PALM COAST FL
32164-6635
US

V. Phone/Fax

Practice location:
  • Phone: 386-405-8544
  • Fax:
Mailing address:
  • Phone: 386-405-8544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License NumberPN5239054
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5239054
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License NumberPN5239054
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberPN5239054
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: