Provider Demographics
NPI:1780071274
Name:WATNICK, JERETT YALE (DO)
Entity type:Individual
Prefix:
First Name:JERETT
Middle Name:YALE
Last Name:WATNICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9552 SAVONA WINDS DR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-9751
Mailing Address - Country:US
Mailing Address - Phone:561-441-5925
Mailing Address - Fax:
Practice Address - Street 1:7481 W OAKLAND PARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-4985
Practice Address - Country:US
Practice Address - Phone:954-771-7743
Practice Address - Fax:954-771-7748
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS155602084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry