MEDICARE: ELLY BETTANEY BSN, BS, RN

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	163WC0200X	Critical Care Medicine Registered Nurse	2530049	MN
2	390200000X	Student in an Organized Health Care Education/Training Program	RN9706533	FL

General Provider Information

NPI Number	:	1841116365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLY BETTANEY BSN, BS, RN

Provider Business Mailing Address
First Line	:	124 S FRANKLIN ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-5328
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 S FRANKLIN ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-5328
Country	:	US
Telephone Number	:	813-224-7840
Fax Number	:

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

Provider Enumeration Date	:	06/29/2026
Last Update Date	:	06/29/2026

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