Healthcare Provider Details

I. General information

NPI: 1780420828
Provider Name (Legal Business Name): JULIAN BECKFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2593 PINWHERRY ST NW
PALM BAY FL
32907-6845
US

IV. Provider business mailing address

2593 PINWHERRY ST NW
PALM BAY FL
32907-6845
US

V. Phone/Fax

Practice location:
  • Phone: 908-296-0244
  • Fax:
Mailing address:
  • Phone: 908-296-0244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041.538203
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: