Provider Demographics
NPI:1043276686
Name:BESWICK, CARLA R (FNP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:R
Last Name:BESWICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5799 STETSON HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-4223
Mailing Address - Country:US
Mailing Address - Phone:719-471-2273
Mailing Address - Fax:719-380-0228
Practice Address - Street 1:4130 N FREEWAY RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2064
Practice Address - Country:US
Practice Address - Phone:719-471-2273
Practice Address - Fax:719-380-0228
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169428363L00000X
VA0017140066363L00000X
TNAPN07168363LF0000X
TNRN104737363LF0000X
CO0992053363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3348948Medicare PIN
P88784Medicare UPIN