Healthcare Provider Details

I. General information

NPI: 1912652157
Provider Name (Legal Business Name): JENNIFER LOUISE BETTIS RRT - RESPIRATORY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2181 ORANGE AVE E
TALLAHASSEE FL
32311-6144
US

IV. Provider business mailing address

2013 TYSON GREEN AVE
TALLAHASSEE FL
32310-4965
US

V. Phone/Fax

Practice location:
  • Phone: 850-878-0191
  • Fax:
Mailing address:
  • Phone: 850-590-8256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: