MEDICARE: JEANNE RYAN BOTZ ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1630102	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508825407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE RYAN BOTZ ARNP

Provider Business Mailing Address
First Line	:	8002 KING HELIE BLVD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-1435
Country	:	US
Telephone Number	:	727-841-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	33920 US HIGHWAY 19 N STE 107
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-2654
Country	:	US
Telephone Number	:	727-781-1000
Fax Number	:	727-330-7551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	10/07/2022

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