Provider Demographics
NPI:1659017374
Name:WATSON, SETH
Entity Type:Individual
Prefix:MR
First Name:SETH
Middle Name:
Last Name:WATSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12443 SAN JOSE BLVD STE 604
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8652
Mailing Address - Country:US
Mailing Address - Phone:904-944-4625
Mailing Address - Fax:904-734-7410
Practice Address - Street 1:12443 SAN JOSE BLVD STE 604
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8652
Practice Address - Country:US
Practice Address - Phone:904-444-4625
Practice Address - Fax:904-734-7410
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY50835363LP0808X
ID74098363LP0808X
NH089637-23363LP0808X
NDR53168363LP0808X
KS53-81592-042363LP0808X
DEL8-0010372363LP0808X
TX1096480364SP0808X
FL11021532363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health