Healthcare Provider Details

I. General information

NPI: 1932319498
Provider Name (Legal Business Name): LONNIE D WATTS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HERON BAY RD
JACKSONVILLE FL
32218-3595
US

IV. Provider business mailing address

145 HERON BAY RD
JACKSONVILLE FL
32218-3595
US

V. Phone/Fax

Practice location:
  • Phone: 904-470-6900
  • Fax:
Mailing address:
  • Phone: 904-470-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9571011
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL40638
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11051089
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: