Provider Demographics
NPI:1184071730
Name:BEARDSLEY, BRUCE BRIAN JR (ARNP)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:BRIAN
Last Name:BEARDSLEY
Suffix:JR
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5623 ORTEGA FARMS BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-2335
Mailing Address - Country:US
Mailing Address - Phone:904-994-2706
Mailing Address - Fax:
Practice Address - Street 1:12058 SAN JOSE BLVD
Practice Address - Street 2:STE 1003
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8667
Practice Address - Country:US
Practice Address - Phone:904-321-9875
Practice Address - Fax:904-321-9890
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9273193363LP0808X
FL9273193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108369900Medicaid