Provider Demographics
NPI:1952310765
Name:WATKINS, NICOLE FRANK (PT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:FRANK
Last Name:WATKINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3932 N 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2807
Mailing Address - Country:US
Mailing Address - Phone:850-434-7755
Mailing Address - Fax:850-469-0858
Practice Address - Street 1:916 E FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2817
Practice Address - Country:US
Practice Address - Phone:850-434-7755
Practice Address - Fax:850-469-0858
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT208392251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890185600Medicaid