Healthcare Provider Details

I. General information

NPI: 1356427967
Provider Name (Legal Business Name): BETTY ANN DUPONT STAPLETON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 S CENTRAL AVE
UMATILLA FL
32784-2325
US

IV. Provider business mailing address

PO DRAWER 2325
UMATILLA FL
32784-2325
US

V. Phone/Fax

Practice location:
  • Phone: 352-669-3175
  • Fax: 352-669-3640
Mailing address:
  • Phone: 352-669-3175
  • Fax: 352-669-3640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP2558022
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: