Provider Demographics
NPI:1699117408
Name:BELL, BETHANY JEAN
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:JEAN
Last Name:BELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:JEAN
Other - Last Name:SAMUELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1824 KING ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4736
Mailing Address - Country:US
Mailing Address - Phone:904-388-1820
Mailing Address - Fax:904-388-1827
Practice Address - Street 1:1824 KING ST
Practice Address - Street 2:SUITE 300
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4736
Practice Address - Country:US
Practice Address - Phone:904-388-1820
Practice Address - Fax:904-388-1827
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9277309363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily