Healthcare Provider Details

I. General information

NPI: 1629200894
Provider Name (Legal Business Name): JASON BEAU DELUISA ANP,CNP, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 02/01/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1577 C ST
ANCHORAGE AK
99501-5127
US

IV. Provider business mailing address

15919 29TH ST E
PARRISH FL
34219-1854
US

V. Phone/Fax

Practice location:
  • Phone: 941-348-6927
  • Fax: 907-865-2433
Mailing address:
  • Phone: 505-331-0295
  • Fax: 907-865-2433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number117659
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-01518
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number117659
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: