Provider Demographics
NPI:1043425689
Name:FLORA-WATERMAN, REBECCA ELLEN (APRN, FNP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ELLEN
Last Name:FLORA-WATERMAN
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 BLUFF CITY HWY
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-6055
Mailing Address - Country:US
Mailing Address - Phone:423-573-9873
Mailing Address - Fax:
Practice Address - Street 1:1615 BLUFF CITY HWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-6055
Practice Address - Country:US
Practice Address - Phone:423-573-9873
Practice Address - Fax:866-551-3252
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
TN22280363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No174400000XOther Service ProvidersSpecialist