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General NPI Number Information
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NPI Number | 1336612951
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Entity Type | Individual
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Provider Name | MARY B BEACH
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Gender | Female
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Dates
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Enumeration Date | 01/07/2019
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 12 ZINNIAS CT
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City | HOMOSASSA
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State | FL
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Zip | 34446-5628
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Country | US
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Telephone | 727-560-8780
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Fax |
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Provider Business Mailing Address
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Address Line | 12 ZINNIAS CT
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City | HOMOSASSA
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State | FL
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Zip | 34446-5628
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Country | US
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Telephone | 727-512-7596
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 1059541
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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