Provider Demographics
NPI:1376044560
Name:WATSON, TAMMY RAE (RN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:RAE
Last Name:WATSON
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 1:1400 E RUNDBERG LN APT 127
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-4943
Mailing Address - Country:US
Mailing Address - Phone:512-945-4768
Mailing Address - Fax:
Practice Address - Street 1:13915 BURNET RD STE 303
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-6505
Practice Address - Country:US
Practice Address - Phone:512-996-9559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX590185163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse