Provider Demographics
NPI:1710474465
Name:WATKINS, MARILYN LOUISE
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:LOUISE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 BAKER AVE
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-3505
Mailing Address - Country:US
Mailing Address - Phone:863-533-5852
Mailing Address - Fax:863-533-5852
Practice Address - Street 1:620 BAKER AVE
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-3505
Practice Address - Country:US
Practice Address - Phone:863-533-5852
Practice Address - Fax:863-533-5852
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6905707374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide