Provider Demographics
NPI:1801065693
Name:BEARDSLEY, JOSEPH H (AP-DOM)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:H
Last Name:BEARDSLEY
Suffix:
Gender:M
Credentials:AP-DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 S FLORIDA AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3327
Mailing Address - Country:US
Mailing Address - Phone:863-644-2447
Mailing Address - Fax:
Practice Address - Street 1:6700 S FLORIDA AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3327
Practice Address - Country:US
Practice Address - Phone:863-644-2447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2539171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist