Healthcare Provider Details

I. General information

NPI: 1184373466
Provider Name (Legal Business Name): ANA EVELYN WATTERS NMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 STEINBECK PL
PLANT CITY FL
33566-0761
US

IV. Provider business mailing address

3320 STEINBECK PL
PLANT CITY FL
33566-0761
US

V. Phone/Fax

Practice location:
  • Phone: 813-836-1781
  • Fax:
Mailing address:
  • Phone: 813-836-1781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberCH.VHV.05153
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: