Provider Demographics
NPI:1760675417
Name:WATSON, MARY BUNKER (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BUNKER
Last Name:WATSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6109 ELECTRA LN
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-8117
Mailing Address - Country:US
Mailing Address - Phone:850-497-8288
Mailing Address - Fax:
Practice Address - Street 1:6109 ELECTRA LN
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-8117
Practice Address - Country:US
Practice Address - Phone:850-497-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-095066363LW0102X
FL9176697363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health