Healthcare Provider Details

I. General information

NPI: 1902182447
Provider Name (Legal Business Name): BEATRICE E HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5838 SOUTEL DR.
JACKSONVILLE FL
32219
US

IV. Provider business mailing address

5838 SOUTEL DR.
JACKSONVILLE FL
32219-3738
US

V. Phone/Fax

Practice location:
  • Phone: 904-465-5471
  • Fax:
Mailing address:
  • Phone: 904-465-5471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License NumberFB 9721679
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA 248500
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: