Provider Demographics
NPI:1699527606
Name:WATTS, NICOLE MARIE (APRN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:WATTS
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 N PARK RD
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-2026
Mailing Address - Country:US
Mailing Address - Phone:813-757-8343
Mailing Address - Fax:
Practice Address - Street 1:3202 N PARK RD
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-2026
Practice Address - Country:US
Practice Address - Phone:813-833-0637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9477285163WL0100X, 163WN0003X, 163WX0003X
FLAPRN11032215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient