Provider Demographics
NPI:1154381382
Name:WILLIAMS, ANGELIQUE NICOLE (AUDIOLOGIST)
Entity type:Individual
Prefix:MS
First Name:ANGELIQUE
Middle Name:NICOLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:AUDIOLOGIST
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Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP EIP PEDIATRICS
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-7262
Practice Address - Fax:904-798-4546
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAY643231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000895903AMedicaid
GA000895903BMedicaid
FL6001505-00Medicaid
FL6001505-00Medicaid