Provider Demographics
NPI:1114323490
Name:WATANABE, NEDA RUTH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NEDA
Middle Name:RUTH
Last Name:WATANABE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1347 ARDMORE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3440
Mailing Address - Country:US
Mailing Address - Phone:904-860-0332
Mailing Address - Fax:
Practice Address - Street 1:1679 EAGLE HARBOR PKWY STE B
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4816
Practice Address - Country:US
Practice Address - Phone:904-264-1958
Practice Address - Fax:904-264-1677
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2023-08-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9108361363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant