Healthcare Provider Details

I. General information

NPI: 1114072824
Provider Name (Legal Business Name): SUZANNE MICHELE WILLIAMS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W KENNEDY BLVD 114
TAMPA FL
33609-2288
US

IV. Provider business mailing address

10711 MCINTOSH RD
THONOTOSASSA FL
33592-3946
US

V. Phone/Fax

Practice location:
  • Phone: 813-639-1915
  • Fax: 813-514-4715
Mailing address:
  • Phone: 813-986-6496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9230496
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: