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NPI Code Detail

MEDICARE: DAMILA PINA BETANCOURT

MEDICARE: DAMILA PINA BETANCOURT
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
1363L00000XNurse Practitioner11021724FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AG09220007OTHERAANP
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629799333
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAMILA PINA BETANCOURT
Provider Business Mailing Address
First Line : 2307 BOLADO PKWY
Second Line :
City : CAPE CORAL
State : FL
Zip : 33990-2712
Country : US
Telephone Number : 239-424-8122
Fax Number :
Provider Business Practice Location Address
First Line : 2307 BOLADO PKWY
Second Line :
City : CAPE CORAL
State : FL
Zip : 33990-2712
Country : US
Telephone Number : 239-424-8122
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2022
Last Update Date : 09/14/2023

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Directions to “ DAMILA PINA BETANCOURT ” Practice Location

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