Provider Demographics
NPI:1700992898
Name:BEVAN, JEFFREY L (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:L
Last Name:BEVAN
Suffix:
Gender:M
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 TURIN TER STE 110
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-0849
Mailing Address - Country:US
Mailing Address - Phone:904-819-7200
Mailing Address - Fax:904-814-8936
Practice Address - Street 1:70 TURIN TER STE 110
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-0849
Practice Address - Country:US
Practice Address - Phone:904-819-7200
Practice Address - Fax:904-814-8936
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9438247363LF0000X
OHAPRN.CNP.08962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCD3781OtherMEDICARE RAILROAD
OH2761300Medicaid
OH2761300Medicaid