Provider Demographics
NPI:1770685927
Name:WATTS, ROSE MARIE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:MARIE
Last Name:WATTS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 SAINT JOHNS AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-6859
Mailing Address - Country:US
Mailing Address - Phone:386-325-5699
Mailing Address - Fax:386-325-5644
Practice Address - Street 1:6100 SAINT JOHNS AVE STE 6
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177
Practice Address - Country:US
Practice Address - Phone:386-325-5699
Practice Address - Fax:386-325-5644
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2514352363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY013QOtherBCBS
FL304546300Medicaid
FL304546300Medicaid