Healthcare Provider Details

I. General information

NPI: 1093047375
Provider Name (Legal Business Name): JENNIFER M WATSON PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5214 SW 91ST TERRACE SUITE A
GAINESVILLE FL
32608
US

IV. Provider business mailing address

5214 SW 91ST TERRACE SUITE A
GAINESVILLE FL
32608
US

V. Phone/Fax

Practice location:
  • Phone: 352-337-0551
  • Fax: 352-374-2166
Mailing address:
  • Phone: 352-337-0551
  • Fax: 352-374-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7111
License Number StateFL

VIII. Authorized Official

Name: MRS. JENNIFER M WATSON
Title or Position: OWNER
Credential: PH.D.
Phone: 352-337-0551