Provider Demographics
NPI:1619963469
Name:KASPER, ELIZABETH ANN BEVAN (ARNP, FNP-C, DCNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN BEVAN
Last Name:KASPER
Suffix:
Gender:F
Credentials:ARNP, FNP-C, DCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 BELFORT ROAD SOUTH
Mailing Address - Street 2:STE 130
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6017
Mailing Address - Country:US
Mailing Address - Phone:727-867-5480
Mailing Address - Fax:888-507-9833
Practice Address - Street 1:5220 BELFORT ROAD SOUTH
Practice Address - Street 2:STE 130
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6017
Practice Address - Country:US
Practice Address - Phone:727-867-5480
Practice Address - Fax:888-507-9833
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2804142163WW0000X
FLFL2804142363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8420OtherBCBS
FL002418600Medicaid
FLY8420OtherBCBS
FL002418600Medicaid
FL$$$$$$$$$OtherCHAMPUS/TRICARE