Provider Demographics
NPI:1013559723
Name:WATTS, ALEXANDRIA ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:ROSE
Last Name:WATTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 BISCAYNE BLVD APT 3604
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1569
Mailing Address - Country:US
Mailing Address - Phone:239-293-0513
Mailing Address - Fax:
Practice Address - Street 1:2920 NE 207TH ST STE 901
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-1444
Practice Address - Country:US
Practice Address - Phone:786-833-8607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2022-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant