Healthcare Provider Details

I. General information

NPI: 1437077625
Provider Name (Legal Business Name): JACKERIA BEARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 PALM POINTE CT APT 216
FORT MYERS FL
33907-3076
US

IV. Provider business mailing address

8397 ANTIGUA CT
FORT MYERS FL
33907-4001
US

V. Phone/Fax

Practice location:
  • Phone: 352-875-5844
  • Fax:
Mailing address:
  • Phone: 352-875-5844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: