Healthcare Provider Details

I. General information

NPI: 1386424133
Provider Name (Legal Business Name): JENNIFER MICHELLE BETTLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 INITIATIVE BLVD SUITE 101
SARASOTA FL
34240
US

IV. Provider business mailing address

5505 SUMMIT GLN
BRADENTON FL
34203-1205
US

V. Phone/Fax

Practice location:
  • Phone: 941-388-8997
  • Fax: 941-306-5876
Mailing address:
  • Phone: 214-934-3756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11028881
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: