Provider Demographics
NPI:1487980462
Name:WILLIAMS, GLORIA A (LPTA)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 WINDHAM RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-8375
Mailing Address - Country:US
Mailing Address - Phone:814-952-0125
Mailing Address - Fax:
Practice Address - Street 1:5500 WINDHAM RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-8375
Practice Address - Country:US
Practice Address - Phone:814-952-0125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 25405314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility