Healthcare Provider Details

I. General information

NPI: 1881945491
Provider Name (Legal Business Name): CAROLYN O'NISE WATKINS RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16521 NW 1ST AVENUE
MIAMI FL
33169
US

IV. Provider business mailing address

16521 NW 1 AV
MIAMI FL
33169
US

V. Phone/Fax

Practice location:
  • Phone: 305-947-7261
  • Fax: 305-945-9890
Mailing address:
  • Phone: 305-947-7261
  • Fax: 305-945-9890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRRT11739
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: