Provider Demographics
NPI:1326652579
Name:WATSON, LINDA D (NP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:D
Last Name:WATSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10550 BAYMEADOWS RD UNIT 430
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4526
Mailing Address - Country:US
Mailing Address - Phone:636-222-7247
Mailing Address - Fax:
Practice Address - Street 1:2525 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2549
Practice Address - Country:US
Practice Address - Phone:321-966-2646
Practice Address - Fax:321-966-2647
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020023118207Q00000X
FLAPRN11008623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL878495Medicaid