Healthcare Provider Details

I. General information

NPI: 1700146776
Provider Name (Legal Business Name): GRACE WATSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 SAINT GILES RD
PALM BEACH GARDENS FL
33418-3704
US

IV. Provider business mailing address

9 SAINT GILES RD
PALM BEACH GARDENS FL
33418-3704
US

V. Phone/Fax

Practice location:
  • Phone: 561-624-8217
  • Fax: 561-799-0384
Mailing address:
  • Phone: 561-624-8217
  • Fax: 561-799-0384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number2056662
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: