Provider Demographics
NPI:1811050909
Name:WALTERS, JUDITH ANN (DNP, APRN, PMHCNS-BC)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:DNP, APRN, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 SE 47TH ST STE 112
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-9602
Mailing Address - Country:US
Mailing Address - Phone:239-448-4949
Mailing Address - Fax:239-946-0232
Practice Address - Street 1:1222 SE 47TH ST STE 112
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9602
Practice Address - Country:US
Practice Address - Phone:239-448-5959
Practice Address - Fax:239-946-0232
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY484602364SP0809X
FLCNS9349898364SP0809X
FLAPRN9349898364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA1748Medicare PIN