Basic Information
| Provider Information | |||||||||
| NPI: | 1578998456 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEIDER | ||||||||
| FirstName: | BEVERLEY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4020 SUN CITY CENTER BLVD | ||||||||
| Address2: | SUITE #1 | ||||||||
| City: | SUN CITY CENTER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335735285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136345502 | ||||||||
| FaxNumber: | 8136332702 | ||||||||
| Practice Location | |||||||||
| Address1: | 228 W ALEXANDER ST | ||||||||
| Address2: | #100 | ||||||||
| City: | PLANT CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335637157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137545480 | ||||||||
| FaxNumber: | 8137542251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2013 | ||||||||
| LastUpdateDate: | 06/03/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9260866 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.