Provider Demographics
NPI:1750013157
Name:CAMILUS, WATSON
Entity Type:Individual
Prefix:
First Name:WATSON
Middle Name:
Last Name:CAMILUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 SANDPIPER BAY CIR APT I205
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-5650
Mailing Address - Country:US
Mailing Address - Phone:239-692-4420
Mailing Address - Fax:
Practice Address - Street 1:3051 SANDPIPER BAY CIR APT I205
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-5650
Practice Address - Country:US
Practice Address - Phone:239-692-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-26
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9430192163WM0705X
FL11020841363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical