Provider Demographics
NPI:1306036777
Name:BEVERLY ENCARNACION, M.D., P.A.
Entity Type:Organization
Organization Name:BEVERLY ENCARNACION, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENCARNACION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-736-7733
Mailing Address - Street 1:2128 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5604
Mailing Address - Country:US
Mailing Address - Phone:727-736-7733
Mailing Address - Fax:727-736-7740
Practice Address - Street 1:2128 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5604
Practice Address - Country:US
Practice Address - Phone:727-736-7733
Practice Address - Fax:727-736-7740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME007280261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care