Healthcare Provider Details

I. General information

NPI: 1316933229
Provider Name (Legal Business Name): BEVERLY BROWN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 GOLFVIEW AVE
BARTOW FL
33830-6736
US

IV. Provider business mailing address

PO BOX 1559
BARTOW FL
33831-1559
US

V. Phone/Fax

Practice location:
  • Phone: 863-519-3750
  • Fax: 863-534-7028
Mailing address:
  • Phone: 863-519-0575
  • Fax: 863-534-7028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP1176052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: