Provider Demographics
NPI:1750742136
Name:NAUGLE, BETHANY (PA-C)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:NAUGLE
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 1:943 S BENEVA RD STE 306
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2473
Mailing Address - Country:US
Mailing Address - Phone:941-362-8644
Mailing Address - Fax:941-954-4440
Practice Address - Street 1:943 S BENEVA RD STE 306
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2473
Practice Address - Country:US
Practice Address - Phone:941-362-8644
Practice Address - Fax:941-954-4440
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMN6169177363A00000X
PAMA058138363AM0700X
FLPA9110483363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant