Becky Cervenka

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

9352433 Issued in FL

Practice address

9900 Bren Rd E
Minnetonka, MN 55343-9664

Phone

(708) 814-6930

NPI assigned

Mar 27, 2007

Last updated

Sep 9, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1083732960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17087 OHARA DR",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339482255",
            "telephone_number": "708-814-6930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9900 BREN RD E",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553439664",
            "telephone_number": "708-814-6930"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17087 OHara Dr",
            "address_purpose": "LOCATION",
            "city": "Port Charlotte",
            "state": "FL",
            "postal_code": "339482255",
            "country_code": "US",
            "telephone_number": "708-814-6930",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CERVENKA",
        "first_name": "BECKY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-27",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "2248",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209-004543",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9352433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.