MEDICARE: MS. BEVERLEY W. SPALDING ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	9177730	FL

General Provider Information

NPI Number	:	1013181213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BEVERLEY W. SPALDING ARNP

Provider Business Mailing Address
First Line	:	PO BOX 110637
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32911-0637
Country	:	US
Telephone Number	:	201-233-4018
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 DATON RD SW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32908-7518
Country	:	US
Telephone Number	:	321-723-4820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	04/17/2008

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