Provider Demographics
NPI:1407280001
Name:WATSON, CYNTHIA ANICE (MS CGG)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANICE
Last Name:WATSON
Suffix:
Gender:F
Credentials:MS CGG
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:ANICE
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:877 EXECUTIVE CENTER DR W
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2460
Mailing Address - Country:US
Mailing Address - Phone:760-670-4551
Mailing Address - Fax:
Practice Address - Street 1:877 EXECUTIVE CENTER DR W
Practice Address - Street 2:SUITE 206
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2460
Practice Address - Country:US
Practice Address - Phone:760-670-4551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS