Provider Demographics
NPI:1609281245
Name:SCHUTZBACH, BETTINA DENNISE (MD)
Entity Type:Individual
Prefix:DR
First Name:BETTINA
Middle Name:DENNISE
Last Name:SCHUTZBACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETTINA
Other - Middle Name:DENNISE
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-532-1355
Mailing Address - Fax:813-635-2613
Practice Address - Street 1:6801 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-6844
Practice Address - Country:US
Practice Address - Phone:727-822-3238
Practice Address - Fax:727-823-1278
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD461313207Q00000X
SC37209207Q00000X
FLME141448207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104976100Medicaid