Provider Demographics
NPI:1750749388
Name:REAVES, BEVERLY (RN)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:
Last Name:REAVES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 HOMECOMING WAY
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33868-5151
Mailing Address - Country:US
Mailing Address - Phone:757-647-0526
Mailing Address - Fax:
Practice Address - Street 1:569 HOMECOMING WAY
Practice Address - Street 2:
Practice Address - City:POLK CITY
Practice Address - State:FL
Practice Address - Zip Code:33868-5151
Practice Address - Country:US
Practice Address - Phone:757-647-0526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9380727163W00000X
VA0001061507163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse