Provider Demographics
NPI:1811050909
Name:WALTERS, JUDITH ANN (APRN, PMHCNS-BC)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:APRN, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4526 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-8340
Mailing Address - Country:US
Mailing Address - Phone:239-314-6417
Mailing Address - Fax:
Practice Address - Street 1:6820 PORTO FINO CIR STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7141
Practice Address - Country:US
Practice Address - Phone:239-225-1364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNS9349898364SP0809X
NY484602364SP0809X
FLAPRN9349898364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA1748Medicare PIN