Provider Demographics
NPI:1962109835
Name:BEDOSKY, MATTHEW ANTHONY (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ANTHONY
Last Name:BEDOSKY
Suffix:
Gender:M
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 7TH AVE N
Mailing Address - Street 2:
Mailing Address - City:TIERRA VERDE
Mailing Address - State:FL
Mailing Address - Zip Code:33715-1819
Mailing Address - Country:US
Mailing Address - Phone:813-294-6024
Mailing Address - Fax:
Practice Address - Street 1:11125 PARK BLVD STE 118
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-4700
Practice Address - Country:US
Practice Address - Phone:813-294-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024433363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner