Provider Demographics
NPI:1346837663
Name:WALSH, JUDITH (RN)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2264 SW BROOKHAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-5751
Mailing Address - Country:US
Mailing Address - Phone:516-971-9922
Mailing Address - Fax:
Practice Address - Street 1:2264 SW BROOKHAVEN WAY
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-5751
Practice Address - Country:US
Practice Address - Phone:516-971-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9439000163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency