Provider Demographics
NPI:1033797642
Name:WATERS, ERICA DEVETIA (APRN)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:DEVETIA
Last Name:WATERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1586 BRANNAN FIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-9062
Mailing Address - Country:US
Mailing Address - Phone:904-406-6303
Mailing Address - Fax:904-406-6509
Practice Address - Street 1:1586 BRANNAN FIELD ROAD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068
Practice Address - Country:US
Practice Address - Phone:904-406-6303
Practice Address - Fax:904-406-6509
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012485363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner