1598795742 NPI number — BEVERLY B. NYSEWANDER MSN ARNP

Table of content: BEVERLY B. NYSEWANDER MSN ARNP (NPI 1598795742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598795742 NPI number — BEVERLY B. NYSEWANDER MSN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NYSEWANDER
Provider First Name:
BEVERLY
Provider Middle Name:
B.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NYSEWANDER
Provider Other First Name:
BEVERLY
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN ARNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1598795742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2080 CHILD STREET
Provider Second Line Business Mailing Address:
NAVAL HOSPITAL JACKSONVILLE INTERNAL MEDICINE CLINIC
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-542-7310
Provider Business Mailing Address Fax Number:
904-542-7913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2080 CHILD STREET
Provider Second Line Business Practice Location Address:
INTERNAL MEDICINE
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-542-7310
Provider Business Practice Location Address Fax Number:
904-542-7913
Provider Enumeration Date:
07/04/2006

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: 363LF0000X , with the licence number:  ARNP3342232 , 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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