Provider Demographics
NPI:1518212091
Name:PUNZALAN, BEVERLY (RN)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:
Last Name:PUNZALAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18255 NW 68TH AVE
Mailing Address - Street 2:APT 510
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3459
Mailing Address - Country:US
Mailing Address - Phone:786-527-1510
Mailing Address - Fax:
Practice Address - Street 1:18255 NW 68TH AVE
Practice Address - Street 2:APT 510
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3459
Practice Address - Country:US
Practice Address - Phone:786-527-1510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9345053163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse