=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538877501
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAUNETEKA WILLIAMS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2022
-----------------------------------------------------
Last Update Date | 11/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 217 SE 1ST AVE STE 200
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471-2161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-632-5032
-----------------------------------------------------
Fax | 352-632-5031
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1237 NE 39TH RD
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34470-0903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-286-6903
-----------------------------------------------------
Fax | 352-632-5031
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC1600X
-----------------------------------------------------
Taxonomy Name | Continuing Education/Staff Development Registered Nurse
-----------------------------------------------------
License Number | RN9394922
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WH0500X
-----------------------------------------------------
Taxonomy Name | Hemodialysis Registered Nurse
-----------------------------------------------------
License Number | RN9394922
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number | RN9394922
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------