Individual provider Active NPI

Jennifer Lee Williams, DNP, FNP-C

  • Family Nurse Practitioner
  • New Smyrna Beach, FL
National Provider Identifier
1083134076
Registry record updated Oct 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
9444708 Issued in FL
Practice address
845 State Road 44
New Smyrna Beach, FL 32168
Phone
(386) 425-2550
NPI assigned
Jun 21, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 9444708 FL Primary

Addresses

Primary practice location

845 State Road 44
New Smyrna Beach, FL 32168

Mailing address

845 State Road 44
New Smyrna Beach, FL 32168-7271
Phone (386) 425-2550

Other practice location 1

1690 Dunlawton Ave Ste 120
Port Orange, FL 32127-8980
Phone (386) 271-2273

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180412002864 FL Practitioner - Nurse Practitioner 2961765573 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Halifax Healthcare Systems IncGroup PAC ID 1254238090, 345 clinicians

Practice addresses (Care Compare)

303 N Clyde Morris Blvd
Daytona BCH, FL 32114-2709

807 State Rd
Suite 44
New Smyrna, FL 32168-7271
Phone (386) 428-5554

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9444708FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
G Fredrick Herdel MD PA CurrentSince Oct 7, 2019 Accepting new patients
Halifax Healthcare Systems Inc CurrentSince Mar 23, 2023 Accepting new patients

Locations

303 N Clyde Morris Blvd
Daytona Beach, FL 32114
Phone (386) 425-2285

845 State Road 44
New Smyrna Beach, FL 32168
Phone (386) 423-2550

807 State Road 44
New Smyrna Beach, FL 32168
Phone (386) 428-5554

1690 Dunlawton Ave
Pt Orange, FL 32127
Phone (386) 274-1744

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: jennifer.williams.1@16462.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570320000000",
    "number": "1083134076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 STATE ROAD 44",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321687271",
            "telephone_number": "386-425-2550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 STATE ROAD 44",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "32168",
            "telephone_number": "386-425-2550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1690 Dunlawton Ave Ste 120",
            "address_purpose": "LOCATION",
            "city": "Port Orange",
            "state": "FL",
            "postal_code": "321278980",
            "country_code": "US",
            "telephone_number": "386-271-2273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "JENNIFER",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "DNP, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-21",
        "last_updated": "2019-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9444708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Smyrna Beach, FL

Sources for this page

Verify at the official NPI Registry.