Provider Demographics
NPI:1750589636
Name:WATKINS, ANGIE LUCIA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:LUCIA
Last Name:WATKINS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:DAHMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4600 S MILL AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-6850
Mailing Address - Country:US
Mailing Address - Phone:480-305-2888
Mailing Address - Fax:480-305-2889
Practice Address - Street 1:223 W COLE BLVD
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-9722
Practice Address - Country:US
Practice Address - Phone:760-344-9951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200550134NP FNP-PP363LF0000X
AZAP7565363LF0000X
CA15453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ238036Medicaid
OR500664640Medicaid
AZ238036Medicaid