Individual
PRISCILLA WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4901 JEFFERSON ST, HOLLYWOOD, FL 33021-7627
(954) 482-3360
(954) 894-1188
Mailing address
4901 JEFFERSON ST, HOLLYWOOD, FL 33021-7627
(954) 482-3360
(954) 894-1188
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
AL12519
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
W436671717290
—
FL
Enumeration date
01/21/2017
Last updated
01/21/2017
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