Provider Demographics
NPI:1619536554
Name:WATFORD, LINDSEY (FNP)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:WATFORD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 E VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3064
Mailing Address - Country:US
Mailing Address - Phone:941-282-3376
Mailing Address - Fax:941-282-3378
Practice Address - Street 1:1415 E VENICE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3064
Practice Address - Country:US
Practice Address - Phone:941-282-3376
Practice Address - Fax:941-282-3378
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020928363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-148862OtherAL MEDICAL LICENSE
FLAPRN11020928OtherAPRN