Active NPI
Tracy N Watford
- Personal Care Attendant
- Middleburg, FL
National Provider Identifier
1013489202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Personal Care Attendant
- License
- 004319100
- Practice address
- 2720 Anchor Rd
Middleburg, FL 32068-5600 - Phone
- (904) 704-6012
- NPI assigned
- Dec 28, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Personal Care Attendant | 3747P1801X | 004319100 | FL | Primary |
Addresses
Primary practice location
2720 Anchor Rd
Middleburg, FL 32068-5600
Mailing address
2720 Anchor Rd
Middleburg, FL 32068-5600
Phone (904) 704-6012
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004319100 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004319100 | FL | MD | Personal Care Attendant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545955200000",
"number": "1013489202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2720 ANCHOR RD",
"city": "MIDDLEBURG",
"state": "FL",
"postal_code": "320685600",
"telephone_number": "904-704-6012"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2720 ANCHOR RD",
"city": "MIDDLEBURG",
"state": "FL",
"postal_code": "320685600",
"telephone_number": "904-704-6012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATFORD",
"first_name": "TRACY",
"middle_name": "N",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-12-28",
"last_updated": "2018-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "3747P1801X",
"taxonomy_group": "",
"desc": "Technician, Personal Care Attendant",
"state": "FL",
"license": "004319100",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004319100",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Middleburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.