MEDICARE: MRS. LAKISHA F WILLIAMS-NOUKHAL 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	363L00000X	Nurse Practitioner	11003056	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700438066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAKISHA F WILLIAMS-NOUKHAL APRN

Provider Business Mailing Address
First Line	:	PO BOX 1141
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33575-1141
Country	:	US
Telephone Number	:	727-644-3191
Fax Number	:

Provider Business Practice Location Address
First Line	:	2260 ROANOKE SPRINGS DR
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33570-6314
Country	:	US
Telephone Number	:	727-644-3191
Fax Number	:

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

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	07/16/2019

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