Provider Demographics
NPI:1598585739
Name:WATSON, TYRANESE
Entity type:Individual
Prefix:
First Name:TYRANESE
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 WOODLAKE DR APT D227
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-7141
Mailing Address - Country:US
Mailing Address - Phone:863-614-6570
Mailing Address - Fax:
Practice Address - Street 1:1475 WOODLAKE DR APT D227
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-7141
Practice Address - Country:US
Practice Address - Phone:863-614-6570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula