Provider Demographics
NPI:1588965388
Name:WATSON, AUDREY
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 VALRICO HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-6778
Mailing Address - Country:US
Mailing Address - Phone:866-367-4316
Mailing Address - Fax:
Practice Address - Street 1:2126 VALRICO HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-6778
Practice Address - Country:US
Practice Address - Phone:813-689-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2015-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies