Provider Demographics
NPI:1508825407
Name:BOTZ, JEANNE RYAN (ARNP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:RYAN
Last Name:BOTZ
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 1:8002 KING HELIE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-1435
Mailing Address - Country:US
Mailing Address - Phone:727-841-4200
Mailing Address - Fax:
Practice Address - Street 1:33920 US HIGHWAY 19 N STE 107
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2654
Practice Address - Country:US
Practice Address - Phone:727-781-1000
Practice Address - Fax:727-330-7551
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1630102363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL034829500Medicaid
Y5568AMedicare ID - Type Unspecified