Provider Demographics
NPI:1073776126
Name:WATSON, ANIKA NINA (MD)
Entity Type:Individual
Prefix:
First Name:ANIKA NINA
Middle Name:
Last Name:WATSON
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 1:2805 E OAKLAND PARK BLVD # 186
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1813
Mailing Address - Country:US
Mailing Address - Phone:954-762-1027
Mailing Address - Fax:
Practice Address - Street 1:2805 E OAKLAND PARK BLVD # 186
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1813
Practice Address - Country:US
Practice Address - Phone:954-762-1027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA797322085R0202X
WI721052085R0202X
ORMD2012162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology