Provider Demographics
NPI:1063850493
Name:WATERS, AMANDA K (CRNA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:WATERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 SW 34TH CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-3392
Mailing Address - Country:US
Mailing Address - Phone:352-237-0509
Mailing Address - Fax:352-237-9808
Practice Address - Street 1:3309 SW 34TH CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-3392
Practice Address - Country:US
Practice Address - Phone:352-237-0509
Practice Address - Fax:352-237-9808
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9182170367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered