Provider Demographics
NPI:1003865189
Name:BOTTS, KOREAN ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:KOREAN
Middle Name:ANN
Last Name:BOTTS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 MONTEREY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-2817
Mailing Address - Country:US
Mailing Address - Phone:941-995-9122
Mailing Address - Fax:
Practice Address - Street 1:22089 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2364
Practice Address - Country:US
Practice Address - Phone:727-287-2784
Practice Address - Fax:727-669-9260
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1838862363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY008QOtherBCBS
FLE3922UMedicare ID - Type Unspecified
FLY008QOtherBCBS