Healthcare Provider Details

I. General information

NPI: 1508747460
Provider Name (Legal Business Name): ANGELA L BEARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 5TH AVE N
ST PETERSBURG FL
33713-7521
US

IV. Provider business mailing address

12344 CEDAR PASS TRL
PARRISH FL
34219-8348
US

V. Phone/Fax

Practice location:
  • Phone: 727-367-2273
  • Fax:
Mailing address:
  • Phone: 727-409-1253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH27629
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: