Provider Demographics
NPI:1740873744
Name:FOLKS, WILLAMINA (AGACNP-BC, CCRN)
Entity type:Individual
Prefix:
First Name:WILLAMINA
Middle Name:
Last Name:FOLKS
Suffix:
Gender:F
Credentials:AGACNP-BC, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 ANDREW AVILES CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-5005
Mailing Address - Country:US
Mailing Address - Phone:863-399-9477
Mailing Address - Fax:
Practice Address - Street 1:1027 ANDREW AVILES CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-5005
Practice Address - Country:US
Practice Address - Phone:863-399-9477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007666363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP7G70OtherBLUE CROSS BLUE SHIELD
FL112734000Medicaid