Healthcare Provider Details

I. General information

NPI: 1528054509
Provider Name (Legal Business Name): ANTOININA WATKINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 W SWANN AVE STE 303
TAMPA FL
33609-4051
US

IV. Provider business mailing address

3806 W SANTIAGO ST
TAMPA FL
33629-7812
US

V. Phone/Fax

Practice location:
  • Phone: 813-569-0740
  • Fax: 813-864-7603
Mailing address:
  • Phone: 813-277-4073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME89921
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: