1619963469 NPI number — MRS. ELIZABETH ANN BEVAN KASPER ARNP, FNP-C, DCNP

Table of content: MRS. ELIZABETH ANN BEVAN KASPER ARNP, FNP-C, DCNP (NPI 1619963469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619963469 NPI number — MRS. ELIZABETH ANN BEVAN KASPER ARNP, FNP-C, DCNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KASPER
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN BEVAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP, FNP-C, DCNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619963469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5220 BELFORT ROAD SOUTH
Provider Second Line Business Mailing Address:
STE 130
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32256-6017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-867-5480
Provider Business Mailing Address Fax Number:
888-507-9833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5220 BELFORT ROAD SOUTH
Provider Second Line Business Practice Location Address:
STE 130
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32256-6017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-867-5480
Provider Business Practice Location Address Fax Number:
888-507-9833
Provider Enumeration Date:
09/26/2005

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: 163WW0000X , with the licence number:  ARNP2804142 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: FL2804142 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: Y8420 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 002418600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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