Healthcare Provider Details

I. General information

NPI: 1104457738
Provider Name (Legal Business Name): EMILIE NOELL WILLIAMS MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2020
Last Update Date: 01/13/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 N MONROE ST
TALLAHASSEE FL
32303-4733
US

IV. Provider business mailing address

2122 BUCKHEAD AVE
GRAND RIDGE FL
32442-3959
US

V. Phone/Fax

Practice location:
  • Phone: 850-385-6664
  • Fax:
Mailing address:
  • Phone: 260-350-4123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9488788
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11015254
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: