Provider Demographics
NPI:1710517438
Name:THOPPIL WATTKIS, RENNY KURIAKOSE (APRN)
Entity Type:Individual
Prefix:
First Name:RENNY
Middle Name:KURIAKOSE
Last Name:THOPPIL WATTKIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:RENNY
Other - Middle Name:KURIAKOSE
Other - Last Name:THOPPIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15322 92ND CT N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33412-1767
Mailing Address - Country:US
Mailing Address - Phone:561-281-1441
Mailing Address - Fax:
Practice Address - Street 1:15322 92ND CT N
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33412-1767
Practice Address - Country:US
Practice Address - Phone:561-281-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005646363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily