Provider Demographics
NPI:1053694539
Name:WILLIAMS SOUFFRANT, TASSCIA M (MD)
Entity type:Individual
Prefix:
First Name:TASSCIA
Middle Name:M
Last Name:WILLIAMS SOUFFRANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-361-5615
Mailing Address - Fax:
Practice Address - Street 1:61 THOMAS JOHNSON DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4301
Practice Address - Country:US
Practice Address - Phone:301-663-6171
Practice Address - Fax:301-695-4469
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD458253207V00000X
MDD85692207V00000X
FLME149269207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD85692OtherSTATE LICENSE
FLPENDINGMedicaid
FLPENDINGOtherMEDICARE HF
FLPENDINGOtherMEDICARE HF