Provider Demographics
NPI:1588813562
Name:MICHAEL, BEVERLY LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:LYNN
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2334 SOUTH 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-1979
Mailing Address - Country:US
Mailing Address - Phone:904-261-6135
Mailing Address - Fax:904-261-9998
Practice Address - Street 1:2334 SOUTH 8TH STREET
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1979
Practice Address - Country:US
Practice Address - Phone:904-261-6135
Practice Address - Fax:904-261-9998
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101209363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical