Healthcare Provider Details

I. General information

NPI: 1356268080
Provider Name (Legal Business Name): SAMANTHA DAISY WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13244 STATE ROAD 54
ODESSA FL
33556-3483
US

IV. Provider business mailing address

23156 SELKIRK AVE
BROOKSVILLE FL
34601-5144
US

V. Phone/Fax

Practice location:
  • Phone: 813-310-5905
  • Fax:
Mailing address:
  • Phone: 813-310-5905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN9487811
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: