Provider Demographics
NPI:1538174396
Name:BETHEA, CHRISTINE C (ARNP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:C
Last Name:BETHEA
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 1:300 CABANA BLVD
Mailing Address - Street 2:2406
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-4563
Mailing Address - Country:US
Mailing Address - Phone:850-636-7088
Mailing Address - Fax:850-636-7071
Practice Address - Street 1:4408 DELWOOD LN
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-7492
Practice Address - Country:US
Practice Address - Phone:850-636-7088
Practice Address - Fax:850-636-7071
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1087792363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health