Provider Demographics
NPI:1083138622
Name:MCQUEEN, BETHANY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 VALENTINE ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3127
Mailing Address - Country:US
Mailing Address - Phone:321-586-5444
Mailing Address - Fax:
Practice Address - Street 1:1335 VALENTINE ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3127
Practice Address - Country:US
Practice Address - Phone:321-586-5444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9321760363LF0000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health