1528054509 NPI number — DR. ANTOININA WATKINS MD

Table of content: DR. ANTOININA WATKINS MD (NPI 1528054509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528054509 NPI number — DR. ANTOININA WATKINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATKINS
Provider First Name:
ANTOININA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528054509
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3806 W SANTIAGO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33629-7812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-277-4073
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2919 W SWANN AVE STE 303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33609-4051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-569-0740
Provider Business Practice Location Address Fax Number:
813-864-7603
Provider Enumeration Date:
09/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  ME89921 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 271373000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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