Individual
LISA WILLIAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
114 3RD ST SE, FORT WALTON BEACH, FL 32548-5401
(850) 243-6134
(850) 243-9759
Mailing address
253 E MARIGOLD AVE, DEFUNIAK SPRINGS, FL 32433-6518
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
PN 5150203
FL
Other
Enumeration date
12/29/2009
Last updated
12/29/2009
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