MEDICARE: MR. TYRONE FRAY WILLIAMS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN25491122	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508402843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TYRONE FRAY WILLIAMS APRN

Provider Business Mailing Address
First Line	:	9500 NW 77TH AVE STE 18
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-2522
Country	:	US
Telephone Number	:	305-364-0017
Fax Number	:	305-826-8826

Provider Business Practice Location Address
First Line	:	9500 NW 77TH AVE STE 18
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-2522
Country	:	US
Telephone Number	:	305-364-0017
Fax Number	:	305-826-8826

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2019
Last Update Date	:	11/27/2023

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