MEDICARE: MR. BRUCE BRIAN BEARDSLEY JR. 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP9273193	FL
2	363LF0000X	Family Nurse Practitioner	9273193	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184071730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRUCE BRIAN BEARDSLEY JR. ARNP

Provider Business Mailing Address
First Line	:	5623 ORTEGA FARMS BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-2335
Country	:	US
Telephone Number	:	904-994-2706
Fax Number	:

Provider Business Practice Location Address
First Line	:	12058 SAN JOSE BLVD
Second Line	:	STE 1003
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8667
Country	:	US
Telephone Number	:	904-321-9875
Fax Number	:	904-321-9890

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

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	04/30/2021

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