Jucknath, Beverly Suzanne

Jucknath, Beverly Suzanne is an individual health care provider with primary practice located at 3003 W Dr Martin Luther King Jr Blvd Fl 2 , Tampa FL 33607-6307. She recently has 3 registered licenses in different health care specialties including Nursing Service Providers / Critical Care Medicine, Physician Assistants & Advanced Practice Nursing Providers / Adult Health, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Jucknath, Beverly Suzanne can be contacted via phone (813) 321-6580.

Contact Information

Primary practice address
3003 W Dr Martin Luther King Jr Blvd Fl 2 Tampa FL 33607-6307
Phone: (813) 321-6580
Fax: (813) 443-8185
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Critical Care Medicine 163WC0200X RN9361508 Florida
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X APRN11003292 Florida
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X APRN11003292 Florida

Profile Details

NPI number 1235693268
LBN Legal business name Jucknath, Beverly Suzanne
Credentials APRN-C
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 23rd, 2019
Last updated Jun 14th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235693268 NPPES
Florida MEDICAID 106459800

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