Provider Demographics
NPI:1659331270
Name:ENCARNACION, BEVERLY (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:ENCARNACION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5604
Mailing Address - Country:US
Mailing Address - Phone:727-736-7733
Mailing Address - Fax:727-736-7740
Practice Address - Street 1:2128 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5604
Practice Address - Country:US
Practice Address - Phone:727-736-7733
Practice Address - Fax:727-736-7740
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME007280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254970100Medicaid
FL43411OtherBLUE CROSS BLUE SHIELD
FLP00061262OtherRAILROAD MEDICARE
FLP00061262OtherRAILROAD MEDICARE
FLP00061262OtherRAILROAD MEDICARE
FLG16074Medicare UPIN