Provider Demographics
NPI:1972595841
Name:BEVINS, JENNIFER L (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BEVINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1890 SW HEALTH PKWY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0473
Mailing Address - Country:US
Mailing Address - Phone:239-593-0990
Mailing Address - Fax:239-593-0812
Practice Address - Street 1:1890 SW HEALTH PKWY
Practice Address - Street 2:SUITE 303
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0473
Practice Address - Country:US
Practice Address - Phone:239-593-0990
Practice Address - Fax:239-593-0812
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2009-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME87742207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267180800Medicaid
FLH87568Medicare UPIN
FL267180800Medicaid