Provider Demographics
NPI:1346024809
Name:WATRY, PETER DONALD (RN)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:DONALD
Last Name:WATRY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10733 ORCHARD WALK PL W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-6927
Mailing Address - Country:US
Mailing Address - Phone:330-324-0935
Mailing Address - Fax:
Practice Address - Street 1:10733 ORCHARD WALK PL W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6927
Practice Address - Country:US
Practice Address - Phone:330-324-0935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9535936163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse