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1215891072 NPI number — JEANETTA WATTS-MITCHELL

NPI Number: 1215891072
Health Care Provider/Practitioner: JEANETTA WATTS-MITCHELL

Information about “1215891072” NPI (JEANETTA WATTS-MITCHELL) exists in 1215891072 in HTML format HTML  |  1215891072 in plain Text format TXT  |  1215891072 in PDF (Portable Document Format) PDF  |  1215891072 in an XML format XML  formats.

NPI Number : 1215891072 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215891072",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WATTS-MITCHELL",
    "FirstName": "JEANETTA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WATTS",
    "OtherFirstName": "JEANETTA",
    "OtherMiddleName": "HOPE",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "941 29TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WEST PALM BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33407-5034",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "561-574-2564",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "10625 N MILITARY TRL STE 102",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WEST PALM BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33410-6548",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "561-249-7626",
    "PracticeLocationAddressFaxNumber": "561-249-7713",
    "EnumerationDate": "12/15/2025",
    "LastUpdateDate": "12/15/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "APRN11044159",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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