Healthcare Provider Details

I. General information

NPI: 1922486844
Provider Name (Legal Business Name): MADELINE WATERS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8787 BRYAN DAIRY RD STE 210
LARGO FL
33777-1253
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 727-397-9641
  • Fax: 727-393-4194
Mailing address:
  • Phone: 239-274-8200
  • Fax: 239-278-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP9308862
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: