Healthcare Provider Details

I. General information

NPI: 1801204425
Provider Name (Legal Business Name): KATREASHE MOLTAK WATSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 GRANT ST
BRIDGEPORT CT
06610-2805
US

IV. Provider business mailing address

1600 LAKELAND HILLS BLVD
LAKELAND FL
33805-3065
US

V. Phone/Fax

Practice location:
  • Phone: 203-384-3000
  • Fax:
Mailing address:
  • Phone: 863-680-7000
  • Fax: 866-264-8519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9318430
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: