Provider Demographics
NPI:1225118490
Name:BEVERLY, EDITH F (ARNP)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:F
Last Name:BEVERLY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 2ND ST E
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1042
Mailing Address - Country:US
Mailing Address - Phone:941-754-7564
Mailing Address - Fax:941-745-7567
Practice Address - Street 1:206 2ND ST E
Practice Address - Street 2:SUITE A
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1042
Practice Address - Country:US
Practice Address - Phone:941-745-7564
Practice Address - Fax:941-745-7567
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1263672363LF0000X
FL1263672363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL320740OtherAMERIGROUP
FL308068400Medicaid
FL320740OtherAMERIGROUP
FL308068400Medicaid
P33214Medicare UPIN
FLE 1099ZMedicare ID - Type Unspecified