Provider Demographics
NPI:1679535793
Name:BEVERS, M. JOANNE (CNM,MSN)
Entity type:Individual
Prefix:MS
First Name:M.
Middle Name:JOANNE
Last Name:BEVERS
Suffix:
Gender:F
Credentials:CNM,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 LAKEWOOD RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5185
Mailing Address - Country:US
Mailing Address - Phone:941-907-3008
Mailing Address - Fax:941-907-3036
Practice Address - Street 1:8340 LAKEWOOD RANCH BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5180
Practice Address - Country:US
Practice Address - Phone:941-907-3008
Practice Address - Fax:941-907-3036
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1838602367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP1838602OtherMEDICAL LICENSE NUMBER
FLY5961ZMedicare ID - Type Unspecified