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General NPI Number Information
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NPI Number | 1396620035
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Entity Type | Individual
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Provider Name | GRACE WATTS ARNP
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Gender | Female
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Dates
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Enumeration Date | 08/11/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 900 INGRAHAM AVE # 4336
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City | HAINES CITY
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State | FL
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Zip | 33844-4336
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Country | US
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Telephone | 863-421-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 929 JAMES TRL
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City | LAKE ALFRED
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State | FL
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Zip | 33850-2726
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Country | US
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Telephone | 863-307-8800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11041602
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License Number State | FL
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