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General NPI Number Information
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NPI Number | 1184071730
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Entity Type | Individual
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Provider Name | BRUCE BRIAN BEARDSLEY JR. ARNP
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Gender | Male
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 12058 SAN JOSE BLVD STE 1003
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8667
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Country | US
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Telephone | 904-321-9875
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Fax | 904-321-9890
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Provider Business Mailing Address
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Address Line | 5623 ORTEGA FARMS BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32244-2335
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Country | US
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Telephone | 904-994-2706
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | ARNP9273193
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9273193
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License Number State | FL
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