Healthcare Provider Details

I. General information

NPI: 1124988605
Provider Name (Legal Business Name): PAIGE BECK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 HIDDENBROOK PL
ST JOHNS FL
32259-7517
US

IV. Provider business mailing address

286 HIDDENBROOK PL
ST JOHNS FL
32259-7517
US

V. Phone/Fax

Practice location:
  • Phone: 904-616-3470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN9538348
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: