Individual
MS. LAURA NANCE BEVERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1522 PENMAN RD., JACKSONVILLE BEACH, FL 32250
(904) 253-2555
(904) 270-2559
Mailing address
900 UNIVERSITY BLVD. NORTH, MC 75, JACKSONVILLE, FL 32211
(904) 253-2062
(904) 253-1942
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME59866
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3740781-01
—
FL
05
—
374078101
—
FL
Enumeration date
05/12/2006
Last updated
01/02/2013
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