Provider Demographics
NPI:1225670466
Name:GLANTON, BETTHINA RYSHETT
Entity Type:Individual
Prefix:
First Name:BETTHINA
Middle Name:RYSHETT
Last Name:GLANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5208 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3785
Mailing Address - Country:US
Mailing Address - Phone:813-690-7128
Mailing Address - Fax:
Practice Address - Street 1:5208 WATSON RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3785
Practice Address - Country:US
Practice Address - Phone:813-690-7128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide