Healthcare Provider Details

I. General information

NPI: 1962279810
Provider Name (Legal Business Name): TANNIS BEAUDET MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 S PRAIRIE LAKES DR
ST AUGUSTINE FL
32084-9318
US

IV. Provider business mailing address

114 S PRAIRIE LAKES DR
ST AUGUSTINE FL
32084-9318
US

V. Phone/Fax

Practice location:
  • Phone: 904-343-0660
  • Fax:
Mailing address:
  • Phone: 904-343-0660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11030086
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: