Provider Demographics
NPI:1467804054
Name:WATSON, TIFFANY ALENA (CNA)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:ALENA
Last Name:WATSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 E CHURCH LN APT G1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-1443
Mailing Address - Country:US
Mailing Address - Phone:267-437-0264
Mailing Address - Fax:
Practice Address - Street 1:709 E CHURCH LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1436
Practice Address - Country:US
Practice Address - Phone:267-423-2426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10001903376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide