Provider Demographics
NPI:1346412913
Name:PRATOR, BETTINA C (ARNP)
Entity Type:Individual
Prefix:
First Name:BETTINA
Middle Name:C
Last Name:PRATOR
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 1:3000 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4680
Mailing Address - Country:US
Mailing Address - Phone:813-615-7030
Mailing Address - Fax:813-615-8350
Practice Address - Street 1:3000 MEDICAL PARK DR
Practice Address - Street 2:SUITE 310
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4680
Practice Address - Country:US
Practice Address - Phone:813-615-7030
Practice Address - Fax:813-615-8350
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2994312363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY087COtherBLUE CROSS BLUE SHIELD
FL307322000Medicaid
FL307322000Medicaid
FLU6677YMedicare PIN