Provider Demographics
NPI:1265534291
Name:WATSON, PETER JAMES (CRNA)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:JAMES
Last Name:WATSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:PETER
Other - Middle Name:JAMES
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2692 N.E. HWY. 70 LOT 413
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266
Mailing Address - Country:US
Mailing Address - Phone:863-494-4929
Mailing Address - Fax:
Practice Address - Street 1:900 N ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-8765
Practice Address - Country:US
Practice Address - Phone:863-494-3535
Practice Address - Fax:863-491-4200
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2643862367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG1690YMedicare PIN