Provider Demographics
NPI:1104033190
Name:BEDFORD, MARIAN N
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:N
Last Name:BEDFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E OLYMPIA AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3833
Mailing Address - Country:US
Mailing Address - Phone:941-639-1640
Mailing Address - Fax:941-637-9808
Practice Address - Street 1:315 E OLYMPIA AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3833
Practice Address - Country:US
Practice Address - Phone:941-639-1640
Practice Address - Fax:941-637-9808
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9258071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily