Provider Demographics
NPI:1871246249
Name:FITZPATRICK, BETTY JEAN (RN, MSN, PNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:JEAN
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:RN, MSN, PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9890
Mailing Address - Fax:239-343-4191
Practice Address - Street 1:15901 BASS RD STE 102
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3838
Practice Address - Country:US
Practice Address - Phone:239-343-9890
Practice Address - Fax:239-343-4191
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022000108363LP0200X
FLAPRN11018336363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120983300Medicaid