Provider Demographics
NPI:1487172847
Name:WILLIAMS, TINA TERESA
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:TERESA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4214
Mailing Address - Country:US
Mailing Address - Phone:301-401-4607
Mailing Address - Fax:240-668-6767
Practice Address - Street 1:1416 W 12TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4214
Practice Address - Country:US
Practice Address - Phone:301-401-4607
Practice Address - Fax:240-668-6767
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula