Healthcare Provider Details

I. General information

NPI: 1235390352
Provider Name (Legal Business Name): JENNIFER M WATSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5341 SW 91ST TER
GAINESVILLE FL
32608-8108
US

IV. Provider business mailing address

5341 SW 91ST TER
GAINESVILLE FL
32608-8108
US

V. Phone/Fax

Practice location:
  • Phone: 352-256-4904
  • Fax: 352-374-2166
Mailing address:
  • Phone: 352-256-4904
  • Fax: 352-374-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY7111
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPY7111
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7111
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: