Organization
MIND, BODY & MODERN MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. FAITH I BEVAN PA-C (MANAGER)
(727) 992-3440
Entity
Organization
Contact information
Practice address
19401 SHUMARD OAK DR, CLARITY MEDSPA, LAND O'LAKES, FL 34638
(727) 264-1364
Mailing address
8341 CAROLYN DR, PORT RICHEY, FL 34668-6210
(727) 264-1364
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
9101970
FL
Other
Enumeration date
10/23/2014
Last updated
10/23/2014
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