# GINA BOTELLO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1770917429
- **Gender:** F
- **Credential:** FNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LF0000X | Family Nurse Practitioner | AP5180 | AZ | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | AP5180 | AZ | Yes |

## Other

- **Enumeration date:** 08/29/2013
- **Last updated:** 11/15/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 004882 | — | AZ |
| 01 | — | Z176616 | MEDICARE PTAN | AZ |