1033266168 NPI number — MRS. BEVERLY YVETTE HARVEY ITDS

Table of content: MRS. BEVERLY YVETTE HARVEY ITDS (NPI 1033266168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033266168 NPI number — MRS. BEVERLY YVETTE HARVEY ITDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARVEY
Provider First Name:
BEVERLY
Provider Middle Name:
YVETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ITDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSIER
Provider Other First Name:
BEVERLY
Provider Other Middle Name:
Y
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033266168
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2719 COBBLESTONE FOREST CIR W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32225-5760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-641-8608
Provider Business Mailing Address Fax Number:
904-641-8608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3311 BEACH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32207-3704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-396-1462
Provider Business Practice Location Address Fax Number:
904-396-1462
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 222Q00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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