MEDICARE: MISS TIFFANY ALENA WATSON CNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	10001903	PA

General Provider Information

NPI Number	:	1467804054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TIFFANY ALENA WATSON CNA

Provider Business Mailing Address
First Line	:	709 E CHURCH LN APT G1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-1443
Country	:	US
Telephone Number	:	267-437-0264
Fax Number	:

Provider Business Practice Location Address
First Line	:	709 E CHURCH LN
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-1436
Country	:	US
Telephone Number	:	267-423-2426
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	07/07/2016

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