Healthcare Provider Details

I. General information

NPI: 1689474553
Provider Name (Legal Business Name): BEYOND VENACARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S SUMMIT ST STE A
CRESCENT CITY FL
32112-3048
US

IV. Provider business mailing address

PO BOX 366
CRESCENT CITY FL
32112-0366
US

V. Phone/Fax

Practice location:
  • Phone: 386-559-4086
  • Fax:
Mailing address:
  • Phone: 386-559-4086
  • Fax: 386-698-4675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SYLVIA JAIMES
Title or Position: CO-OWNER/DIRECTOR
Credential:
Phone: 386-559-4086