Provider Demographics
NPI:1659983302
Name:WATKINS, JANISSE WALESKA (AGNP-C)
Entity Type:Individual
Prefix:
First Name:JANISSE
Middle Name:WALESKA
Last Name:WATKINS
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6821 SE 100TH PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-9336
Mailing Address - Country:US
Mailing Address - Phone:352-895-6552
Mailing Address - Fax:
Practice Address - Street 1:6821 SE 100TH PL
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-9336
Practice Address - Country:US
Practice Address - Phone:352-895-6552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008601363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health