Individual
JACQUELINE BOTKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
622 W 168TH ST, NEW YORK, NY 10032-3720
(212) 305-9878
(212) 305-8980
Mailing address
622 W 168TH ST, NEW YORK, NY 10032-3720
(212) 305-9878
(212) 305-8980
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
630478
NY
367500000X
Certified Registered Nurse Anesthetist
ARNP2017052
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100496
AVMED
FL
01
—
13181
WELLCARE
FL
01
—
212334
AMERIGROUP OF FL
FL
01
—
430054530
RR MEDICARE
FL
01
—
ARNP2017052
WORKERS COMP
FL
Enumeration date
04/16/2007
Last updated
10/14/2010
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