Provider Demographics
NPI:1659672384
Name:KENNEDY, BETH ANN (ARNP)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANN
Last Name:KENNEDY
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:BEGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 198441
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8441
Mailing Address - Country:US
Mailing Address - Phone:813-745-7365
Mailing Address - Fax:813-449-8618
Practice Address - Street 1:12902 USF MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9416
Practice Address - Country:US
Practice Address - Phone:137-457-3658
Practice Address - Fax:813-449-8618
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN3278072363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFJ430ZMedicare PIN