Healthcare Provider Details

I. General information

NPI: 1336776335
Provider Name (Legal Business Name): BETTY LOU MEIER-FORBES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10925 STATE ROAD 54
NEW PORT RICHEY FL
34655-2277
US

IV. Provider business mailing address

15129 MADEIRA WAY
MADEIRA BEACH FL
33708-1963
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 317-502-0974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11011271
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71009926A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: