Individual
MR. TIMOTHY LEE WATERS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
16420 HEALTHPARK COMMONS DR, FORT MYERS, FL 33908-9621
(239) 985-1925
(239) 321-6044
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 985-1925
(239) 468-7929
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
ARNP9325102
FL
363LA2100X
Acute Care Nurse Practitioner
ARNP 9325102
FL
363LF0000X
Family Nurse Practitioner
APRN9325102
FL
363LG0600X
Gerontology Nurse Practitioner
Primary
APRN9325102
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016793000
—
FL
01
—
1254561
WELLCARE
FL
01
—
398643
AVMED
FL
01
—
4857567
AETNA
FL
01
—
7061863
CIGNA
FL
01
—
P01652219
RR MEDICARE
FL
01
—
P1036301
FREEDOM
FL
01
—
P973771
OPTIMUM
FL
01
—
Y0SY4
BCBS
FL
Enumeration date
07/10/2015
Last updated
08/20/2024
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