Basic Information
| Provider Information | |||||||||
| NPI: | 1619963469 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KASPER | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | ANN BEVAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ARNP, FNP-C, DCNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5220 BELFORT ROAD SOUTH | ||||||||
| Address2: | STE 130 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322566017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278675480 | ||||||||
| FaxNumber: | 8885079833 | ||||||||
| Practice Location | |||||||||
| Address1: | 5220 BELFORT ROAD SOUTH | ||||||||
| Address2: | STE 130 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322566017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278675480 | ||||||||
| FaxNumber: | 8885079833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2005 | ||||||||
| LastUpdateDate: | 07/08/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WW0000X | ARNP2804142 | FL | Y | Nursing Service Providers | Registered Nurse | Wound Care | 363LF0000X | FL2804142 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | Y8420 | 01 | FL | BCBS | OTHER | 002418600 | 05 | FL | MEDICAID |