Individual
MRS. TRACY N WATFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2720 ANCHOR RD, MIDDLEBURG, FL 32068-5600
(904) 704-6012
Mailing address
2720 ANCHOR RD, MIDDLEBURG, FL 32068-5600
(904) 704-6012
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
004319100
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004319100
—
FL
Enumeration date
12/28/2018
Last updated
12/28/2018
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