Healthcare Provider Details

I. General information

NPI: 1356269872
Provider Name (Legal Business Name): KATIE JANE WATSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 OLD CAMP RD STE 180
THE VILLAGES FL
32162-5605
US

IV. Provider business mailing address

910 OLD CAMP RD STE 180
THE VILLAGES FL
32162-5605
US

V. Phone/Fax

Practice location:
  • Phone: 407-680-2026
  • Fax: 407-680-0911
Mailing address:
  • Phone: 407-680-2026
  • Fax: 407-680-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11048897
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: