Provider Demographics
NPI:1235568197
Name:BETTIES, REGINA (CNA)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:BETTIES
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36934
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32412-6934
Mailing Address - Country:US
Mailing Address - Phone:850-640-0056
Mailing Address - Fax:850-640-0481
Practice Address - Street 1:3134 E 6TH PLZ
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-5230
Practice Address - Country:US
Practice Address - Phone:850-640-0056
Practice Address - Fax:850-640-0481
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL169268172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker