Healthcare Provider Details

I. General information

NPI: 1598795742
Provider Name (Legal Business Name): BEVERLY B. NYSEWANDER MSN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BEVERLY B NYSEWANDER MSN ARNP

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD STREET INTERNAL MEDICINE
JACKSONVILLE FL
32214
US

IV. Provider business mailing address

2080 CHILD STREET NAVAL HOSPITAL JACKSONVILLE INTERNAL MEDICINE CLINIC
JACKSONVILLE FL
32214
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7310
  • Fax: 904-542-7913
Mailing address:
  • Phone: 904-542-7310
  • Fax: 904-542-7913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3342232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: