Provider Demographics
NPI:1972536100
Name:PATE, BETTY MICHELLE (ARNP)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:MICHELLE
Last Name:PATE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 MOORINGS CIR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-6647
Mailing Address - Country:US
Mailing Address - Phone:904-264-8760
Mailing Address - Fax:
Practice Address - Street 1:3839 COUNTY ROAD 218
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-5708
Practice Address - Country:US
Practice Address - Phone:904-861-1034
Practice Address - Fax:904-861-1037
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9193741363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP72837Medicare UPIN