MEDICARE: MRS. ROSE MARIE WATTS ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	2514352	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y013Q	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770685927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROSE MARIE WATTS ARNP

Provider Business Mailing Address
First Line	:	6100 SAINT JOHNS AVE STE 6
Second Line	:
City	:	PALATKA
State	:	FL
Zip	:	32177-6859
Country	:	US
Telephone Number	:	386-325-5699
Fax Number	:	386-325-5644

Provider Business Practice Location Address
First Line	:	6100 SAINT JOHNS AVE STE 6
Second Line	:
City	:	PALATKA
State	:	FL
Zip	:	32177
Country	:	US
Telephone Number	:	386-325-5699
Fax Number	:	386-325-5644

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	08/27/2018

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