Healthcare Provider Details

I. General information

NPI: 1144877358
Provider Name (Legal Business Name): LEAH WILLIAMS PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 SUGAR BELLE DR STE J
WINTER GARDEN FL
34787-8385
US

IV. Provider business mailing address

153 SUGAR BELLE DR STE J
WINTER GARDEN FL
34787-8385
US

V. Phone/Fax

Practice location:
  • Phone: 407-203-1682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113459
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: