Provider Demographics
NPI:1548295348
Name:WATSON, TERRY F (CRNA)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:F
Last Name:WATSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 EL PRADO BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-6310
Mailing Address - Country:US
Mailing Address - Phone:305-608-4432
Mailing Address - Fax:
Practice Address - Street 1:4060 EL PRADO BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-6310
Practice Address - Country:US
Practice Address - Phone:305-608-4432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200460034CRNA367500000X
FLARNP 1479742367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG0574WMedicare UPIN