Provider Demographics
NPI:1770906620
Name:WILLIAMS, COUNTISS PATRICE (APRN)
Entity type:Individual
Prefix:
First Name:COUNTISS
Middle Name:PATRICE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 MEDICAL PARK DR STE 340
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4681
Mailing Address - Country:US
Mailing Address - Phone:813-396-9936
Mailing Address - Fax:813-558-1065
Practice Address - Street 1:3000 MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 340
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3361
Practice Address - Country:US
Practice Address - Phone:813-396-9936
Practice Address - Fax:813-558-1065
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9265865363LA2200X
GARN249636363LA2200X
FLAPRN9265865363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHS998ZMedicare PIN
FLHS998YMedicare PIN