Provider Demographics
NPI:1588639199
Name:KRAUSE, BETTY J (ARNP)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:J
Last Name:KRAUSE
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 1:1302 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-5042
Mailing Address - Country:US
Mailing Address - Phone:386-328-8371
Mailing Address - Fax:386-328-1519
Practice Address - Street 1:100 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:KEYSTONE HEIGHTS
Practice Address - State:FL
Practice Address - Zip Code:32656-6802
Practice Address - Country:US
Practice Address - Phone:352-473-6595
Practice Address - Fax:352-473-6597
Is Sole Proprietor?:No
Enumeration Date:2006-02-18
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP422342163WG0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302545400Medicaid
FL302545400Medicaid
FLY7090ZMedicare ID - Type Unspecified99262B
FLY7090Medicare ID - Type Unspecified99262
FLS54065Medicare UPIN
FLY70902Medicare PIN