Provider Demographics
NPI:1912443847
Name:WILLIAMS, TRAVIS JAMES
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:JAMES
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 CALUSA WAY
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-1168
Mailing Address - Country:US
Mailing Address - Phone:208-251-9985
Mailing Address - Fax:
Practice Address - Street 1:1350 MARKET ST STE 202
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1759
Practice Address - Country:US
Practice Address - Phone:509-001-9718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012549363LF0000X
ID54931363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11012549OtherFLORIDA APRN