Healthcare Provider Details

I. General information

NPI: 1386261709
Provider Name (Legal Business Name): CAROL WILLIAMS RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11605 SAINTS RD
JACKSONVILLE FL
32246-3998
US

IV. Provider business mailing address

11605 SAINTS RD
JACKSONVILLE FL
32246-3998
US

V. Phone/Fax

Practice location:
  • Phone: 904-655-7885
  • Fax:
Mailing address:
  • Phone: 904-655-7885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT11903
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: