Healthcare Provider Details

I. General information

NPI: 1891384269
Provider Name (Legal Business Name): ERIN NICOLE BEACH DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 8TH AVE
FORT WORTH TX
76104-3902
US

IV. Provider business mailing address

10332 COLINA DR
FORT WORTH TX
76126-2617
US

V. Phone/Fax

Practice location:
  • Phone: 817-877-5292
  • Fax:
Mailing address:
  • Phone: 585-406-3112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number131022
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: