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NPI Code Detail

MEDICARE: MR. JOHN MARSHALL WATERS APRN

MEDICARE: MR. JOHN MARSHALL WATERS APRN
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
1364SA2200XAdult Health Clinical Nurse Specialist9481932FL

General Provider Information

NPI Number : 1528846342
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN MARSHALL WATERS APRN
Provider Business Mailing Address
First Line : 391 SAINT JOHNS GOLF DR
Second Line :
City : SAINT AUGUSTINE
State : FL
Zip : 32092-1082
Country : US
Telephone Number : 904-463-5981
Fax Number :
Provider Business Practice Location Address
First Line : 800 PRUDENTIAL DR
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8211
Country : US
Telephone Number : 904-202-9180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2023
Last Update Date : 09/21/2023

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