Provider Demographics
NPI:1336193242
Name:NEWTON, BEVERLY S (ARNP)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:S
Last Name:NEWTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:S
Other - Last Name:COATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 UNIVERSITY BLVD. NORTH
Mailing Address - Street 2:MC 75
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211
Mailing Address - Country:US
Mailing Address - Phone:904-253-2062
Mailing Address - Fax:904-253-1942
Practice Address - Street 1:1522 PENMAN RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3744
Practice Address - Country:US
Practice Address - Phone:904-253-2555
Practice Address - Fax:904-270-2559
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP668232363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL034326900Medicaid
FL0343269-00Medicaid
FLY6509ZMedicare PIN
FL034326900Medicaid