Provider Demographics
NPI:1730261579
Name:WILLIAMS, JUDITH (ARNP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 S HARBOR CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1963
Mailing Address - Country:US
Mailing Address - Phone:321-725-5050
Mailing Address - Fax:321-724-9895
Practice Address - Street 1:930 S HARBOR CITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1963
Practice Address - Country:US
Practice Address - Phone:321-725-5050
Practice Address - Fax:321-724-9895
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN655112363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP74281Medicare UPIN