| Courtney Waters, | |
|
11513 N Main St, Jacksonville, FL 32218-4002 | |
| (904) 751-6200 | |
| Not Available |
| Full Name | Courtney Waters |
|---|---|
| Gender | Female |
| Speciality | Physician Assistant |
| Location | 11513 N Main St, Jacksonville, Florida |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639571961 | NPI | - | NPPES |
| KO410 | Other | FL | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | PAT9108237 (Florida) | Secondary |
| 363A00000X | Physician Assistant | PA9108237 (Florida) | Primary |
| Entity Name | Millennium Physician Group LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1811122880 PECOS PAC ID: 9830244433 Enrollment ID: O20090903000338 |
| Mailing Address | Practice Location Address |
|---|---|
| Courtney Waters, 2675 Winkler Ave Fl 2, Fort Myers, FL 33901-9342 Ph: (877) 856-3774 | Courtney Waters, 11513 N Main St, Jacksonville, FL 32218-4002 Ph: (904) 751-6200 |
Katherine L Walsh, PA-C/MPH Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 4500 San Pablo Rd S, Jacksonville, FL 32224 Phone: 904-953-2000 |
Teresa Louise Cowan, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 1200 Riverplace Blvd, Suite 620, Jacksonville, FL 32207 Phone: 904-396-6620 Fax: 904-396-6528 |
Mrs. Melina Volner Sommese, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 4500 San Pablo Rd S, Jacksonville, FL 32224 Phone: 904-953-2594 Fax: 904-953-6225 |
Mr. Thomas Matthew Mattox Jr., PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 15255 Max Leggett Pkwy Ste 5500, Jacksonville, FL 32218 Phone: 904-223-3321 |
Kyle Hollingsworth, PA-C, ATC Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 710 Lomax St, Jacksonville, FL 32204 Phone: 904-355-6583 |
Jessica Defazio, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 836 Prudential Dr Ste 1400, Jacksonville, FL 32207 Phone: 904-388-6518 Fax: 904-384-1005 |
Hangyu Shen Watson, M.D. Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 4500 San Pablo Rd S, Jacksonville, FL 32224 Phone: 904-953-2000 |