Provider Demographics
NPI:1730638636
Name:WATTS, MAMIE EVELYN (CNA)
Entity Type:Individual
Prefix:
First Name:MAMIE
Middle Name:EVELYN
Last Name:WATTS
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 1:501 23RD ST E
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-2739
Mailing Address - Country:US
Mailing Address - Phone:941-448-3127
Mailing Address - Fax:
Practice Address - Street 1:501 23RD ST E
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-2739
Practice Address - Country:US
Practice Address - Phone:941-448-3127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 87278376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide