MEDICARE: TYLICIA WATKINS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	RN50260	DC

General Provider Information

NPI Number	:	1376934166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLICIA WATKINS

Provider Business Mailing Address
First Line	:	12105 WESTLOCK PL
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-2422
Country	:	US
Telephone Number	:	301-775-7841
Fax Number	:

Provider Business Practice Location Address
First Line	:	12105 WESTLOCK PL
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-2422
Country	:	US
Telephone Number	:	301-775-7841
Fax Number	:

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

Provider Enumeration Date	:	02/15/2015
Last Update Date	:	02/15/2015

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Directions to “ TYLICIA WATKINS ” Practice Location

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