Provider Demographics
NPI:1376060111
Name:WATSON, PATRICIA LEMON
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LEMON
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:WRIGHT
Other - Last Name:LEMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:71 JANET DR
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-4614
Mailing Address - Country:US
Mailing Address - Phone:850-926-7385
Mailing Address - Fax:850-643-9479
Practice Address - Street 1:11064 NW DEMPSEY BARRON RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-2622
Practice Address - Country:US
Practice Address - Phone:850-643-9656
Practice Address - Fax:850-643-9479
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1023952363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health