Provider Demographics
NPI:1407921125
Name:FORD, BEVERLY L (NP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:L
Last Name:FORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11647
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-1647
Mailing Address - Country:US
Mailing Address - Phone:386-274-7800
Mailing Address - Fax:386-274-7801
Practice Address - Street 1:595 PETER JEFFERSON PKWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4627
Practice Address - Country:US
Practice Address - Phone:434-982-8504
Practice Address - Fax:434-982-8501
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167141163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0017138706OtherLICENSED NP
VA0024167141OtherVA STATE LICENSE
VI0001097856OtherLICENSE RN