Provider Demographics
NPI:1578164034
Name:WATSON, TERRY (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34171 N CHUCKWALLA TRL
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6053
Mailing Address - Country:US
Mailing Address - Phone:480-390-7540
Mailing Address - Fax:480-988-1855
Practice Address - Street 1:34171 N CHUCKWALLA TRL
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-6053
Practice Address - Country:US
Practice Address - Phone:480-390-7540
Practice Address - Fax:480-988-1855
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN111586163WC0200X
AZ238510363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine