Provider Demographics
NPI:1831385525
Name:WATKINS, CINDY DONNA
Entity type:Individual
Prefix:MS
First Name:CINDY
Middle Name:DONNA
Last Name:WATKINS
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 1:200 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-1833
Mailing Address - Country:US
Mailing Address - Phone:954-895-0295
Mailing Address - Fax:954-533-1425
Practice Address - Street 1:3800 INVERRARY BLVD STE 100P
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4316
Practice Address - Country:US
Practice Address - Phone:954-895-0295
Practice Address - Fax:954-533-1425
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL688093296171M00000X
251C00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688093296Medicaid
FL688093298Medicaid