Provider Demographics
NPI:1639206246
Name:CIROLIA, BETSY SUZANNE (FNP)
Entity Type:Individual
Prefix:MS
First Name:BETSY
Middle Name:SUZANNE
Last Name:CIROLIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WILMOT RD MS # 3113
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4614
Mailing Address - Country:US
Mailing Address - Phone:800-825-5467
Mailing Address - Fax:
Practice Address - Street 1:3505 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2130
Practice Address - Country:US
Practice Address - Phone:904-438-7683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2065772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3331YOtherMEDICARE PTAN
FL3002641 00Medicaid
FL001685500Medicaid
FL001685500Medicaid
FL001685500Medicaid