Healthcare Provider Details

I. General information

NPI: 1629041405
Provider Name (Legal Business Name): JUANITA TODD MCSPADDEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUANITA BETANCOURT ARNP

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 NE FRANKLIN ST
LAKE CITY FL
32055
US

IV. Provider business mailing address

217 NE FRANKLIN ST
LAKE CITY FL
32055
US

V. Phone/Fax

Practice location:
  • Phone: 386-758-1068
  • Fax: 386-758-2180
Mailing address:
  • Phone: 386-758-1068
  • Fax: 386-758-2180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberARNP1372732
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP1372732
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: