Provider Demographics
NPI:1811286123
Name:WILLIAMS, KISHMA NATASHA (FNP)
Entity type:Individual
Prefix:
First Name:KISHMA
Middle Name:NATASHA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14204 COLONIAL LAKES DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-5068
Mailing Address - Country:US
Mailing Address - Phone:347-382-2977
Mailing Address - Fax:
Practice Address - Street 1:509 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-4334
Practice Address - Country:US
Practice Address - Phone:407-277-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDF04180168363L00000X
NYF343982363LF0000X
FLAPRN11012389363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11012389OtherFLORIDA NP LICENSE
MDF04180168OtherNP CERTIFICATION