MEDICARE: PAMELA BEACH APRN

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	363LF0000X	Family Nurse Practitioner	11002831	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619514650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA BEACH APRN

Provider Business Mailing Address
First Line	:	4705 AVON LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4705 AVON LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7503
Country	:	US
Telephone Number	:	904-545-5896
Fax Number	:

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

Provider Enumeration Date	:	12/10/2019
Last Update Date	:	12/10/2019

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Directions to “ PAMELA BEACH APRN” Practice Location

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