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General NPI Number Information
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NPI Number | 1154685410
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Entity Type | Individual
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Provider Name | STACY LYNN WILLIAMS ARNP
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Gender | Female
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Dates
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Enumeration Date | 07/01/2012
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Last Update Date | 07/01/2012
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Provider Practice Location Address
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Address Line | 4280 SOUTHSIDE BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32216-5400
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Country | US
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Telephone | 904-998-3677
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Fax |
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Provider Business Mailing Address
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Address Line | 11334 ASTON HALL DR
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City | JACKSONVILLE
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State | FL
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Zip | 32246-0646
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Country | US
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Telephone | 904-553-5420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9282175
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License Number State | FL
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