Provider Demographics
NPI:1609362144
Name:BETANCOURT VIETA, JEAN EMIL (APRN)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:EMIL
Last Name:BETANCOURT VIETA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:EMIL
Other - Last Name:BETANCOURT VIETA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:445 NW 4TH ST APT 1001
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33128-1704
Mailing Address - Country:US
Mailing Address - Phone:786-419-2166
Mailing Address - Fax:
Practice Address - Street 1:1150 NW 14TH ST STE 309
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2114
Practice Address - Country:US
Practice Address - Phone:305-243-4562
Practice Address - Fax:305-243-3381
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9332807363LF0000X
FL9332807363LF0000X
FLAPRN9332807363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty