Provider Demographics
NPI:1346548872
Name:WYMAN, BEVERLEY ANNE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLEY
Middle Name:ANNE
Last Name:WYMAN
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 1:31 ROCHE BROS WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1032
Mailing Address - Country:US
Mailing Address - Phone:508-894-8730
Mailing Address - Fax:508-894-8732
Practice Address - Street 1:18385 LINGERLON AVE
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-3317
Practice Address - Country:US
Practice Address - Phone:352-275-9826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9172583363L00000X
FLAPRN9172583363LF0000X
MARN-TEMP12962363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y06X7OtherFLORIDA BUE-BCBSFL
FL003409900Medicaid
FL003409900Medicaid