MEDICARE: MR. PETER JAMES WATSON CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	ARNP2643862	FL

General Provider Information

NPI Number	:	1265534291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER JAMES WATSON CRNA

Provider Business Mailing Address
First Line	:	2692 N.E. HWY. 70 LOT 413
Second Line	:
City	:	ARCADIA
State	:	FL
Zip	:	34266
Country	:	US
Telephone Number	:	863-494-4929
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 N ROBERTS AVE
Second Line	:
City	:	ARCADIA
State	:	FL
Zip	:	34266-8765
Country	:	US
Telephone Number	:	863-494-3535
Fax Number	:	863-491-4200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	11/21/2007

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