Healthcare Provider Details

I. General information

NPI: 1801483201
Provider Name (Legal Business Name): CHRISTINE ELLEN WATERHOUSE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

674 PIONEER RD
JUPITER FL
33458-9011
US

IV. Provider business mailing address

PO BOX 734951
CHICAGO IL
60673-4951
US

V. Phone/Fax

Practice location:
  • Phone: 872-231-3162
  • Fax:
Mailing address:
  • Phone: 702-899-0595
  • Fax: 702-977-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11010836
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: