Healthcare Provider Details

I. General information

NPI: 1376678938
Provider Name (Legal Business Name): TIMOTHY NEIL WATKINS R,.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 N 16TH ST BUILDING 10
PHOENIX AZ
85016-5319
US

IV. Provider business mailing address

4212 N 16TH ST PIMC, BUILDING 10
PHOENIX AZ
85016-5319
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-1200
  • Fax: 602-200-5386
Mailing address:
  • Phone: 602-263-1200
  • Fax: 602-200-5386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN108720
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: