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NPI Code Detail

MEDICARE: MS. BEVERLY SUZANNE JUCKNATH APRN-C

MEDICARE: MS. BEVERLY SUZANNE JUCKNATH APRN-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerAPRN11003292FL
2163WC0200XCritical Care Medicine Registered NurseRN9361508FL
3363LG0600XGerontology Nurse Practitioner16816WI
4363L00000XNurse PractitionerGAA-NP002442GA
5363L00000XNurse PractitionerC-APN.0102449-C-NPCO
6363LA2200XAdult Health Nurse PractitionerAPRN11003292FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235693268
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BEVERLY SUZANNE JUCKNATH APRN-C
Provider Business Mailing Address
First Line : 304 E PINE ST UNIT 5355
Second Line :
City : LAKELAND
State : FL
Zip : 33801-4969
Country : US
Telephone Number : 407-496-6186
Fax Number :
Provider Business Practice Location Address
First Line : 2635 N 7TH ST
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81501-8209
Country : US
Telephone Number : 970-298-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2019
Last Update Date : 02/06/2026

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Directions to “ MS. BEVERLY SUZANNE JUCKNATH APRN-C” Practice Location

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