Provider Demographics
NPI:1932952678
Name:WILLIAMS, CHANTA (MA/PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:CHANTA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA/PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5904 NW 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-5654
Mailing Address - Country:US
Mailing Address - Phone:954-861-9390
Mailing Address - Fax:
Practice Address - Street 1:5904 NW 70TH AVE
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-5654
Practice Address - Country:US
Practice Address - Phone:954-861-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy