Provider Demographics
NPI:1295696342
Name:ANI, BETHRAND C
Entity type:Individual
Prefix:
First Name:BETHRAND
Middle Name:C
Last Name:ANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E UNION ST APT 245
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-5803
Mailing Address - Country:US
Mailing Address - Phone:409-781-3130
Mailing Address - Fax:
Practice Address - Street 1:700 E UNION ST APT 245
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-5803
Practice Address - Country:US
Practice Address - Phone:409-781-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-19
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services