Provider Demographics
NPI:1306616800
Name:PRINCIA CHRISTY, TITI WAWA (RN)
Entity type:Individual
Prefix:
First Name:TITI
Middle Name:WAWA
Last Name:PRINCIA CHRISTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2690 DREW ST APT 1012
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3118
Mailing Address - Country:US
Mailing Address - Phone:727-712-7913
Mailing Address - Fax:
Practice Address - Street 1:2690 DREW ST APT 1012
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-3118
Practice Address - Country:US
Practice Address - Phone:727-712-7913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9610617163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse