Healthcare Provider Details

I. General information

NPI: 1013726207
Provider Name (Legal Business Name): SAMUEL L WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 BAY PLAZA BLVD STE 417 PMB 1125
TAMPA FL
33619-4412
US

IV. Provider business mailing address

9225 BAY PLAZA BLVD STE 417 PMB 1125
TAMPA FL
33619-4412
US

V. Phone/Fax

Practice location:
  • Phone: 813-365-3730
  • Fax:
Mailing address:
  • Phone: 813-365-3730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: