Provider Demographics
NPI:1417441742
Name:WATSON, ALISHA (ARNP)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5979 RUSTIC RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-2725
Mailing Address - Country:US
Mailing Address - Phone:386-344-2591
Mailing Address - Fax:
Practice Address - Street 1:1549 AIRPORT BLVD STE 200B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8634
Practice Address - Country:US
Practice Address - Phone:850-416-7838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9310041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine