Provider Demographics
NPI:1245373877
Name:GOODPASTURE, BETTY JEAN (ARNP)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:JEAN
Last Name:GOODPASTURE
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 1:2809 STERLING DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-3029
Mailing Address - Country:US
Mailing Address - Phone:850-385-7190
Mailing Address - Fax:850-385-7190
Practice Address - Street 1:2809 STERLING DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-3029
Practice Address - Country:US
Practice Address - Phone:850-385-7190
Practice Address - Fax:850-385-7190
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2137062363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics