Ms. Beverly S. Jucknath APRN-C
Nurse Practitioner in Tampa, FL(View on Map)
Full Name
Ms. Beverly Suzanne Jucknath APRN-C
NPI Number
1235693268
NPI Type
Individual Provider
Gender
Female
Enumeration Date
01/23/2019
Specialties
(Taxonomies)Code
363L00000X
363LA2200X
163WC0200X
Primary Taxonomy
Yes
No
No
Licenses
State
Florida
Florida
License Number
APRN11003292
RN9361508
Contact
Information
Purpose
Mailing
Location
Address
3003 W DR MLK BLVD FL JR2
3003 W DR MARTIN LUTHER KING JR BLVD FL 2
City
Tampa
Tampa
State
FL
FL
Postal Code
33607-6307
33607-6307
Country
US
US
Telephone Number
(813) 321-6580
(813) 321-6580
Identifiers
Identifier
106459800
Identifier State
FL
Identifier Issuer
Unknown
Health Information Exchange
Endpoint Type
DIRECT
Endpoint
Beverly.Jucknath@direct.mybaycare.org
Endpoint Description
Unknown
Use
Health Information Exchange (HIE)
Content Type
CSV
Affiliation
Y
Endpoint Location
BayCare Medical Group, Inc.2995 Drew StreetEast Bldg 2nd FloorClearwater, FL33759US
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 06/14/2024
Provider Address
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