Healthcare Provider Details

I. General information

NPI: 1396587416
Provider Name (Legal Business Name): JASON BEAU HAMILTON SPEDDEN CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEADOWS RD
BOCA RATON FL
33486-2304
US

IV. Provider business mailing address

2612 GARFIELD ST
HOLLYWOOD FL
33020-3318
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-7100
  • Fax:
Mailing address:
  • Phone: 321-348-6187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: