Provider Demographics
NPI:1700563327
Name:SMITH-WATSON, SOPHIA (CNA)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:SMITH-WATSON
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 1:5338 CHESTERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-5074
Mailing Address - Country:US
Mailing Address - Phone:239-986-0185
Mailing Address - Fax:
Practice Address - Street 1:3361 15TH AVE SW
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34117-5349
Practice Address - Country:US
Practice Address - Phone:954-648-3572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL70130376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty