MEDICARE: MS. MARIE BEAUVIL M.D

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	101YM0800X	Mental Health Counselor		FL

General Provider Information

NPI Number	:	1811390164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIE BEAUVIL M.D

Provider Business Mailing Address
First Line	:	707 25TH ST NW
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-2937
Country	:	US
Telephone Number	:	863-521-5436
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 25TH ST NW
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-2937
Country	:	US
Telephone Number	:	863-521-5436
Fax Number	:

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

Provider Enumeration Date	:	10/01/2014
Last Update Date	:	07/21/2022

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