Provider Demographics
NPI:1336780204
Name:WATSON, CHERRELL
Entity Type:Individual
Prefix:
First Name:CHERRELL
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27251 WESLEY CHAPEL BLVD # B-724
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-4285
Mailing Address - Country:US
Mailing Address - Phone:813-416-9356
Mailing Address - Fax:888-343-9196
Practice Address - Street 1:1717 E CAYUGA ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610
Practice Address - Country:US
Practice Address - Phone:813-416-9356
Practice Address - Fax:888-343-9196
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health