Healthcare Provider Details

I. General information

NPI: 1215891072
Provider Name (Legal Business Name): JEANETTA WATTS-MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. JEANETTA HOPE WATTS

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10625 N MILITARY TRL STE 102
WEST PALM BEACH FL
33410-6548
US

IV. Provider business mailing address

941 29TH ST
WEST PALM BEACH FL
33407-5034
US

V. Phone/Fax

Practice location:
  • Phone: 561-249-7626
  • Fax: 561-249-7713
Mailing address:
  • Phone: 561-574-2564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11044159
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: