Provider Demographics
NPI:1104530856
Name:WATKIN, CAM TU TRAN (NP)
Entity type:Individual
Prefix:
First Name:CAM TU
Middle Name:TRAN
Last Name:WATKIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CAM TU
Other - Middle Name:THI
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6786 CAVATINA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6776
Mailing Address - Country:US
Mailing Address - Phone:808-258-3875
Mailing Address - Fax:
Practice Address - Street 1:6786 CAVATINA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-6776
Practice Address - Country:US
Practice Address - Phone:808-258-3875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV862576363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care