Provider Demographics
NPI:1104916832
Name:WILLIAMS, CLARENCE (CRNA, MS)
Entity type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CRNA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8745 BRAXTON DR
Mailing Address - Street 2:
Mailing Address - City:BAYONET POINT
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6947
Mailing Address - Country:US
Mailing Address - Phone:727-869-0249
Mailing Address - Fax:727-869-0249
Practice Address - Street 1:8745 BRAXTON DR
Practice Address - Street 2:
Practice Address - City:BAYONET POINT
Practice Address - State:FL
Practice Address - Zip Code:34667-6947
Practice Address - Country:US
Practice Address - Phone:727-869-0249
Practice Address - Fax:727-869-0249
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2544102367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG1442Medicare ID - Type Unspecified