Healthcare Provider Details

I. General information

NPI: 1477899458
Provider Name (Legal Business Name): BEAU JASON CARUTHERS ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2012
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 SE 18TH ST SUITE 1002
OCALA FL
34471-5408
US

IV. Provider business mailing address

1740 SE 18TH ST SUITE 1002
OCALA FL
34471-5408
US

V. Phone/Fax

Practice location:
  • Phone: 352-622-1126
  • Fax: 352-622-2391
Mailing address:
  • Phone: 352-622-1126
  • Fax: 352-622-2391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9255567
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: