Provider Demographics
NPI:1508346032
Name:BETTS, LESLIE R
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:R
Last Name:BETTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:R
Other - Last Name:COATS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CDE
Mailing Address - Street 1:109 W KNAPP AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32132-1555
Mailing Address - Country:US
Mailing Address - Phone:386-427-4544
Mailing Address - Fax:386-427-8688
Practice Address - Street 1:109 W KNAPP AVE
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-1555
Practice Address - Country:US
Practice Address - Phone:386-427-4544
Practice Address - Fax:386-427-8688
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9169542163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator