Waters Edge of Bradeton

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL11742 Issued in FL

Legal business name

WATERS EDGE OF BRADETON

Practice address

2015 32ND Ave W
Bradenton, FL 34205-4505

Phone

(941) 748-7797

NPI assigned

Jun 12, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jerry Jaques

Title

President, Rmi, Management Agent

Phone

(386) 774-8878

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339459200000",
    "number": "1144582461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 32ND AVE W",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342054505",
            "telephone_number": "941-748-7797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 32ND AVE W",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342054505",
            "telephone_number": "941-748-7797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERS EDGE OF BRADETON",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-12",
        "last_updated": "2012-06-12",
        "status": "A",
        "authorized_official_last_name": "JAQUES",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "PRESIDENT, RMI, MANAGEMENT AGENT",
        "authorized_official_telephone_number": "386-774-8878"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL11742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tytiki Washington
• Tomasz Wasik
• Edward John Wasloski, O.D.
• Jeffrey R Wasserman, DO
• Angel Wasson, FNP-BC
• Marilyn Leann Waters, FNP
• Melanie Elizabeth Waters
• Waterside Dermatology PLLC
• Veronica Watkins
• Steven C Watsky, MD

• Assisted Living Facility in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.