Provider Demographics
NPI:1336459361
Name:MCWATERS, NIQUIA LYNDSAY (NP)
Entity Type:Individual
Prefix:
First Name:NIQUIA
Middle Name:LYNDSAY
Last Name:MCWATERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 FITZGERALD RD STE 3
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2624
Mailing Address - Country:US
Mailing Address - Phone:863-220-7229
Mailing Address - Fax:
Practice Address - Street 1:140 FITZGERALD RD STE 3
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2624
Practice Address - Country:US
Practice Address - Phone:863-220-7229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9208626363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner