Provider Demographics
NPI:1174983969
Name:BEATTIE, JANINE M (ARNP)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:M
Last Name:BEATTIE
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 1:909 LAKE SHORE DR
Mailing Address - Street 2:104
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-2860
Mailing Address - Country:US
Mailing Address - Phone:561-339-6914
Mailing Address - Fax:
Practice Address - Street 1:3345 BURNS RD
Practice Address - Street 2:302
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4324
Practice Address - Country:US
Practice Address - Phone:561-622-7661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1003436324500000X
FL9233994363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility