MEDICARE: JONAS BEAUGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	236167	FL

General Provider Information

NPI Number	:	1447800495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONAS BEAUGE

Provider Business Mailing Address
First Line	:	1607 SE WALTON LAKES DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-5107
Country	:	US
Telephone Number	:	954-260-6483
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 SE WALTON LAKES DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-5107
Country	:	US
Telephone Number	:	954-260-6483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	09/11/2019

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