Provider Demographics
NPI:1518207943
Name:DECORDOVA, BETH ANN (NP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:DECORDOVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:HONEKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-8531
Mailing Address - Fax:
Practice Address - Street 1:1421 MALABAR RD NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2576
Practice Address - Country:US
Practice Address - Phone:321-434-8531
Practice Address - Fax:321-434-8533
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9433193363LA2200X
MDR214433363LA2200X
CA526244363LA2200X
CA3787364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019314300Medicaid
FLIU177ZOtherMEDICARE HF