Provider Demographics
NPI:1487763231
Name:CHAWK, BEVERLY (ARNP)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:CHAWK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 SOUTHHALL LN STE 300
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:13908 LAKESHORE BLVD STE 240
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-1492
Practice Address - Country:US
Practice Address - Phone:727-868-1312
Practice Address - Fax:727-863-7929
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1178912363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302642600Medicaid
FLS66009Medicare UPIN
FLE1372ZMedicare ID - Type Unspecified