Healthcare Provider Details

I. General information

NPI: 1104480342
Provider Name (Legal Business Name): SANTANA LASHONDA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date: 08/21/2019
Reactivation Date: 09/01/2020

III. Provider practice location address

18001 RICHMOND PLACE DR APT 124
TAMPA FL
33647-1742
US

IV. Provider business mailing address

18001 RICHMOND PLACE DR APT 124
TAMPA FL
33647-1742
US

V. Phone/Fax

Practice location:
  • Phone: 813-316-8933
  • Fax:
Mailing address:
  • Phone: 813-316-8933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: