Healthcare Provider Details

I. General information

NPI: 1851306203
Provider Name (Legal Business Name): COLLETTE WEBSTER-WATSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 POINTE WEST BLVD
BRADENTON FL
34209-5531
US

IV. Provider business mailing address

6002 POINTE WEST BLVD
BRADENTON FL
34209-5531
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-2020
  • Fax: 941-782-1089
Mailing address:
  • Phone: 941-792-2020
  • Fax: 941-782-1089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9102325
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: