Provider Demographics
NPI:1831849306
Name:BETHENCOURT, JOANNE NATALIE (DO)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:NATALIE
Last Name:BETHENCOURT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5722 NW 47TH CT
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32053-2644
Mailing Address - Country:US
Mailing Address - Phone:786-332-9763
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-26
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
FLUO8422207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty