Provider Demographics
NPI:1891918371
Name:BEATTY, ERIN PATRICIA (FNP,ACNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:PATRICIA
Last Name:BEATTY
Suffix:
Gender:F
Credentials:FNP,ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 TIERRA BERIENDA
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1790
Mailing Address - Country:US
Mailing Address - Phone:719-296-0295
Mailing Address - Fax:
Practice Address - Street 1:1619 N GREENWOOD ST
Practice Address - Street 2:SUITE 208
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2644
Practice Address - Country:US
Practice Address - Phone:719-543-6633
Practice Address - Fax:719-543-6655
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN-105714363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily