Healthcare Provider Details

I. General information

NPI: 1285877258
Provider Name (Legal Business Name): TAMMY JEAN WILLIAMS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY MORRIS BROCK

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N TEMPLE AVE
STARKE FL
32091-1960
US

IV. Provider business mailing address

8594 SW 113TH AVE
LAKE BUTLER FL
32054-7471
US

V. Phone/Fax

Practice location:
  • Phone: 904-964-7732
  • Fax: 904-964-3829
Mailing address:
  • Phone: 904-482-2380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2613912
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: