Provider Demographics
NPI:1134790843
Name:WATKINS, PETA JOLLIAN (NP)
Entity type:Individual
Prefix:MRS
First Name:PETA
Middle Name:JOLLIAN
Last Name:WATKINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:PETA
Other - Middle Name:JOLLIAN
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 82969
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-2969
Mailing Address - Country:US
Mailing Address - Phone:813-866-0930
Mailing Address - Fax:813-405-3722
Practice Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6353
Practice Address - Country:US
Practice Address - Phone:813-397-5300
Practice Address - Fax:813-876-0590
Is Sole Proprietor?:No
Enumeration Date:2021-07-03
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11014065363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health