Healthcare Provider Details

I. General information

NPI: 1790426930
Provider Name (Legal Business Name): OLIVIA KIMBERLY BEALE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2022
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 PGA BLVD STE 101
PALM BEACH GARDENS FL
33418-3968
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 561-627-7930
  • Fax: 561-627-9574
Mailing address:
  • Phone: 561-627-7930
  • Fax: 561-627-9574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME172006
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: