Healthcare Provider Details

I. General information

NPI: 1962109835
Provider Name (Legal Business Name): MATTHEW ANTHONY BEDOSKY DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 PARK BLVD STE 118
SEMINOLE FL
33772-4700
US

IV. Provider business mailing address

412 7TH AVE N
TIERRA VERDE FL
33715-1819
US

V. Phone/Fax

Practice location:
  • Phone: 813-294-6024
  • Fax:
Mailing address:
  • Phone: 813-294-6024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11024433
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: