Healthcare Provider Details

I. General information

NPI: 1376468348
Provider Name (Legal Business Name): MS. LAKEISHA EDWENNA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5422 SW 4TH PL
GAINESVILLE FL
32607-2013
US

IV. Provider business mailing address

2525 NW 38TH DR
GAINESVILLE FL
32605-2675
US

V. Phone/Fax

Practice location:
  • Phone: 352-226-5599
  • Fax:
Mailing address:
  • Phone: 352-226-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: