Healthcare Provider Details

I. General information

NPI: 1982174215
Provider Name (Legal Business Name): JENNIFER DENISE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SOUTH 33RD STREET
FORT PIERCE FL
34947
US

IV. Provider business mailing address

P.O.BOX 953
FORT PIERCE FL
34954
US

V. Phone/Fax

Practice location:
  • Phone: 772-672-1476
  • Fax: 772-882-4477
Mailing address:
  • Phone: 772-672-1476
  • Fax: 772-882-4477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: