Healthcare Provider Details

I. General information

NPI: 1518207943
Provider Name (Legal Business Name): BETH ANN DECORDOVA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH ANN HONEKAMP RN

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 MALABAR RD NE
PALM BAY FL
32907-2576
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-8531
  • Fax: 321-434-8533
Mailing address:
  • Phone: 321-434-8531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9433193
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: