Healthcare Provider Details

I. General information

NPI: 1548175698
Provider Name (Legal Business Name): MR. WATSON ELIONARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NW 13TH AVE
BOYNTON BEACH FL
33435-3065
US

IV. Provider business mailing address

6800 BAYFRONT CIR
MARGATE FL
33063-7031
US

V. Phone/Fax

Practice location:
  • Phone: 954-504-1153
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11048911
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF360576-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: