Provider Demographics
NPI:1659998102
Name:WATERS, AMANDA ANNE (APRN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ANNE
Last Name:WATERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 WILDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-3000
Mailing Address - Country:US
Mailing Address - Phone:863-837-8127
Mailing Address - Fax:
Practice Address - Street 1:455 EMERALD AVE
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4716
Practice Address - Country:US
Practice Address - Phone:863-687-1472
Practice Address - Fax:863-687-1494
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008044363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily