Healthcare Provider Details

I. General information

NPI: 1740185958
Provider Name (Legal Business Name): JESSICA BEARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SE OSCEOLA ST STE 302
STUART FL
34994-2347
US

IV. Provider business mailing address

6133 NW REGENT ST
PORT ST LUCIE FL
34983-6404
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-5922
  • Fax:
Mailing address:
  • Phone: 561-506-0476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberRPT29201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: