Nicole Williams

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN11013769 Issued in FL

Practice address

1220 Willis Ave
Daytona Beach, FL 32114-2810

Phone

(800) 539-4228

NPI assigned

Mar 14, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sma Healthcare IncGroup PAC ID 0244226363, 39 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nicole.williams.p1@direct.smahealthcare.nextgenshare.com

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.

• Sma Healthcare Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Daytona Beach, FL
  • NPI 1356329163
  Medicare reassignment Care Compare group NPD
• Sma Healthcare, Inc

  • Federally Qualified Health Center (FQHC)
  • Daytona Beach, FL
  • NPI 1255950168
  NPD
• Sma Healthcare Inc

  • Psychiatric Hospital
  • Daytona Beach, FL
  • NPI 1750369666
  NPD (past)

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

{
    "created_epoch": "1552521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1659830107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MAGNOLIA AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321144304",
            "telephone_number": "386-236-3215",
            "fax_number": "386-236-3178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 WILLIS AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142810",
            "telephone_number": "800-539-4228"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 Justice Ln",
            "address_purpose": "LOCATION",
            "city": "Bunnell",
            "state": "FL",
            "postal_code": "321104487",
            "country_code": "US",
            "telephone_number": "800-539-4228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-14",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "0000186093",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "28387",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "28387",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "ARPN11013769",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN11013769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kylla Danielle Williams, DNP, FNP, PMHNP
• Latecia Williams
• Linda Faye Williams
• Marcia Williams, MSW
• Mariaah Williams, M.D.
• Pamela N Williams
• Rhonda Levette Williams
• Shamica N Williams, CNA
• Sheriefe Cameron Williams, CWCM
• Tanya Leshea Williams, DOCTOR OF PHARMACY

• Psychiatric/Mental Health Nurse Practitioner in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.