Provider Demographics
NPI:1528846342
Name:WATERS, JOHN MARSHALL (APRN)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MARSHALL
Last Name:WATERS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:391 SAINT JOHNS GOLF DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1082
Mailing Address - Country:US
Mailing Address - Phone:904-463-5981
Mailing Address - Fax:
Practice Address - Street 1:800 PRUDENTIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8211
Practice Address - Country:US
Practice Address - Phone:904-202-9180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9481932364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health