Provider Demographics
NPI:1427722628
Name:WILLIAMS, GINA MARIE (CSTFA)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CSTFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4418 MARTINS WAY APT G
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-1134
Mailing Address - Country:US
Mailing Address - Phone:404-461-6021
Mailing Address - Fax:
Practice Address - Street 1:4418 MARTINS WAY APT G
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-1134
Practice Address - Country:US
Practice Address - Phone:404-461-6021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL199806363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical