Basic Information
| Provider Information | |||||||||
| NPI: | 1174983969 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEATTIE | ||||||||
| FirstName: | JANINE | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 909 LAKE SHORE DR | ||||||||
| Address2: | 104 | ||||||||
| City: | LAKE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334032860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613396914 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3345 BURNS RD | ||||||||
| Address2: | 302 | ||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334104324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616227661 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2016 | ||||||||
| LastUpdateDate: | 11/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 1003436 | FL | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 363LF0000X | 9233994 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.