Provider Demographics
NPI:1861784381
Name:WILLIAMS, ANTOINETTE CECILE
Entity type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:CECILE
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 1:3752 BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2517
Mailing Address - Country:US
Mailing Address - Phone:805-369-4935
Mailing Address - Fax:
Practice Address - Street 1:3752 BRIAR LN
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-2517
Practice Address - Country:US
Practice Address - Phone:805-369-4935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLW452003637410343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6389Medicaid
FL6389Medicare PIN