MEDICARE: TASHANDA WATKINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	374U00000X	Home Health Aide
2	376J00000X	Homemaker
3	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1104137934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHANDA WATKINS

Provider Business Mailing Address
First Line	:	1229 PARRISH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-1814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 PARRISH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-1814
Country	:	US
Telephone Number	:	267-345-8581
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2010
Last Update Date	:	06/26/2010

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