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General NPI Number Information
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NPI Number | 1235693268
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Entity Type | Individual
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Provider Name | BEVERLY SUZANNE JUCKNATH APRN-C
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Gender | Female
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 2635 N 7TH ST
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-8209
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Country | US
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Telephone | 970-298-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 304 E PINE ST UNIT 5355
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City | LAKELAND
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State | FL
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Zip | 33801-4969
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Country | US
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Telephone | 407-496-6186
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11003292
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | RN9361508
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | GAA-NP002442
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN11003292
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | C-APN.0102449-C-NP
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License Number State | CO
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