Healthcare Provider Details

I. General information

NPI: 1770048886
Provider Name (Legal Business Name): BETTY VANVIELD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2019
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CELEBRATION PL STE A150
CELEBRATION FL
34747-4970
US

IV. Provider business mailing address

2863 PAYNES PRAIRIE CIR
KISSIMMEE FL
34743-6061
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-3837
  • Fax: 407-303-3838
Mailing address:
  • Phone: 407-301-7739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000821
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: