Healthcare Provider Details

I. General information

NPI: 1205170347
Provider Name (Legal Business Name): HOPE LAUREN WATERMAN A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 W STATE ROAD 436 SUITE 1006
ALTAMONTE SPRINGS FL
32714-2900
US

IV. Provider business mailing address

1022 W STATE ROAD 436 SUITE 1006
ALTAMONTE SPRINGS FL
32714-2900
US

V. Phone/Fax

Practice location:
  • Phone: 407-774-7781
  • Fax: 407-774-7743
Mailing address:
  • Phone: 407-774-7781
  • Fax: 407-774-7743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9292696
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: