Basic Information
| Provider Information | |||||||||
| NPI: | 1972536100 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATE | ||||||||
| FirstName: | BETTY | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1819 MOORINGS CIR | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320686647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042648760 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3839 COUNTY ROAD 218 | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320685708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048611034 | ||||||||
| FaxNumber: | 9048611037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | ARNP9193741 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.