Provider Demographics
NPI:1952310765
Name:WATKINS, NICOLE FRANK (PT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:FRANK
Last Name:WATKINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:CELESTE
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:3921 COLLINGSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6406
Mailing Address - Country:US
Mailing Address - Phone:850-529-8944
Mailing Address - Fax:
Practice Address - Street 1:4624 SUMMERDALE DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32571-1368
Practice Address - Country:US
Practice Address - Phone:850-994-3456
Practice Address - Fax:850-994-3476
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT208392251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890185600Medicaid