Healthcare Provider Details

I. General information

NPI: 1952585853
Provider Name (Legal Business Name): BETSY SUE GEBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TAMPA GENERAL CIR
TAMPA FL
33606-3603
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-7770
US

V. Phone/Fax

Practice location:
  • Phone: 813-259-8812
  • Fax:
Mailing address:
  • Phone: 813-259-8812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberARNP9189980
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: