Individual
JEANNINE RENEE WATERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
303 NORTH CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2709
(386) 254-4210
(386) 254-4212
Mailing address
303 NORTH CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2709
(386) 254-4210
(386) 254-4212
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP2796752
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000400700
—
FL
01
—
ARNP2796752
MEDICAL LICENSE
FL
Enumeration date
09/15/2008
Last updated
04/05/2010
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