Healthcare Provider Details

I. General information

NPI: 1922301159
Provider Name (Legal Business Name): CRISTINA C WATKINS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 12/27/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335R PRAIRIE AVENUE SUITE 1A
PROVIDENCE RI
02905
US

IV. Provider business mailing address

335R PRAIRIE AVENUE SUITE 1A
PROVIDENCE RI
02905
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-4697
  • Fax:
Mailing address:
  • Phone: 401-444-4697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number727575
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN52834
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19829
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNPP37853
License Number StateRI
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN01019
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: