Healthcare Provider Details

I. General information

NPI: 1558604116
Provider Name (Legal Business Name): ADRIENNE MEE-LING WATSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14254 MARTIN LUTHER KING BLVD
DOVER FL
33527-4414
US

IV. Provider business mailing address

13110 ELK MOUNTAIN DR
RIVERVIEW FL
33579-7182
US

V. Phone/Fax

Practice location:
  • Phone: 813-349-7700
  • Fax: 813-938-6422
Mailing address:
  • Phone: 813-349-7569
  • Fax: 813-349-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberRN 9182123
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: