Healthcare Provider Details

I. General information

NPI: 1992063267
Provider Name (Legal Business Name): JENNA BEASLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA BEASLEY M.D.

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6202 N 9TH AVE STE 2
PENSACOLA FL
32504-8291
US

IV. Provider business mailing address

6202 N 9TH AVE STE 2
PENSACOLA FL
32504-8291
US

V. Phone/Fax

Practice location:
  • Phone: 850-888-2424
  • Fax: 620-710-7703
Mailing address:
  • Phone: 508-888-2424
  • Fax: 620-710-7703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberME118808
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME118808
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: