Provider Demographics
NPI:1700992898
Name:BEVAN, JEFFREY L (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:L
Last Name:BEVAN
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 1:324 ENREDE LN
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-7437
Mailing Address - Country:US
Mailing Address - Phone:740-974-3535
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 399
Practice Address - Street 2:
Practice Address - City:GUSTAVUS
Practice Address - State:AK
Practice Address - Zip Code:99826-0399
Practice Address - Country:US
Practice Address - Phone:907-697-3008
Practice Address - Fax:907-697-3034
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK146814363LF0000X
OHAPRN.CNP.08962363LF0000X
FLAPRN9438247363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCD3781OtherMEDICARE RAILROAD
OH2761300Medicaid
OH2761300Medicaid