Healthcare Provider Details

I. General information

NPI: 1750037313
Provider Name (Legal Business Name): AMY ELIZABETH BEACH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E ASH ST
PERRY FL
32347-2029
US

IV. Provider business mailing address

1101 OHIO AVE S
LIVE OAK FL
32064-4146
US

V. Phone/Fax

Practice location:
  • Phone: 850-584-3278
  • Fax:
Mailing address:
  • Phone: 386-339-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11018407
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: