Provider Demographics
NPI:1891112371
Name:BATTISTA, BETHANNE (RN)
Entity Type:Individual
Prefix:
First Name:BETHANNE
Middle Name:
Last Name:BATTISTA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BETHANNE
Other - Middle Name:
Other - Last Name:SKIDMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5000 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1503
Mailing Address - Country:US
Mailing Address - Phone:954-735-6000
Mailing Address - Fax:
Practice Address - Street 1:5000 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1503
Practice Address - Country:US
Practice Address - Phone:954-735-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9330137163W00000X
NY643638163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN9330137OtherSTATE BOARD OF HEALTH
NY643638OtherSTATE BOARD OF HEALTH