Healthcare Provider Details

I. General information

NPI: 1376207340
Provider Name (Legal Business Name): TARA WILLIAMS DNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10360 CITY CENTER BLVD
PEMBROKE PINES FL
33025-4488
US

IV. Provider business mailing address

16000 PINES BLVD UNIT 822701
PEMBROKE PINES FL
33082-9270
US

V. Phone/Fax

Practice location:
  • Phone: 267-663-8354
  • Fax:
Mailing address:
  • Phone: 267-663-8354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number9447460
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number9447460
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number9447460
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: