Healthcare Provider Details

I. General information

NPI: 1184069742
Provider Name (Legal Business Name): CORINNE ARRINGTON WATSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 NW SAINT LUCIE WEST BLVD STE 106
PORT ST LUCIE FL
34986-1719
US

IV. Provider business mailing address

PO BOX 417
STUART FL
34995-0417
US

V. Phone/Fax

Practice location:
  • Phone: 772-785-5505
  • Fax: 772-785-5599
Mailing address:
  • Phone: 772-223-2832
  • Fax: 772-223-5653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2016-01559
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME132785
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number192449
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: