1154355873 NPI number — BETSY CHARLOTTE PARKER ARNP

Table of content: BETSY CHARLOTTE PARKER ARNP (NPI 1154355873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154355873 NPI number — BETSY CHARLOTTE PARKER ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
BETSY
Provider Middle Name:
CHARLOTTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154355873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13020 PARK BLVD
Provider Second Line Business Mailing Address:
OAKHURST MEDICAL CLINIC
Provider Business Mailing Address City Name:
SEMINOLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-393-3404
Provider Business Mailing Address Fax Number:
727-393-4814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 EAST BAY DR
Provider Second Line Business Practice Location Address:
EAST BAY MEDICAL CENTER
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-539-0505
Provider Business Practice Location Address Fax Number:
727-538-0067
Provider Enumeration Date:
07/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP2576892 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)