Provider Demographics
NPI:1104480342
Name:WILLIAMS, SANTANA LASHONDA
Entity type:Individual
Prefix:
First Name:SANTANA
Middle Name:LASHONDA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:FL
Mailing Address - Zip Code:33597-0404
Mailing Address - Country:US
Mailing Address - Phone:813-316-8933
Mailing Address - Fax:
Practice Address - Street 1:3692 CR 752
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:FL
Practice Address - Zip Code:33597-4238
Practice Address - Country:US
Practice Address - Phone:813-316-8933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2020-09-01
Deactivation Date:2019-08-21
Deactivation Code:
Reactivation Date:2020-09-01
Provider Licenses
StateLicense IDTaxonomies
FL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty