Provider Demographics
NPI:1104413160
Name:WATSON, TAMICA (HAIR LOSS SPECIALIS)
Entity type:Individual
Prefix:MS
First Name:TAMICA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIS
Other - Prefix:
Other - First Name:TAMICA
Other - Middle Name:
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HAIR LOSS SPECIALIST
Mailing Address - Street 1:PO BOX 310052
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33680-0052
Mailing Address - Country:US
Mailing Address - Phone:347-832-7946
Mailing Address - Fax:
Practice Address - Street 1:8791 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-6201
Practice Address - Country:US
Practice Address - Phone:347-908-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-24
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1744P3200X
FL1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management