Healthcare Provider Details

I. General information

NPI: 1922167659
Provider Name (Legal Business Name): BEVERLY R GILBERT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 US HIGHWAY 1 STE 103
ROCKLEDGE FL
32955-3745
US

IV. Provider business mailing address

7650 PATTI DR
MERRITT ISLAND FL
32953-6527
US

V. Phone/Fax

Practice location:
  • Phone: 321-632-0552
  • Fax:
Mailing address:
  • Phone: 951-897-7231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11002163
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: