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General NPI Number Information
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NPI Number | 1396971305
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Entity Type | Individual
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Provider Name | ELYSE D BEAUBRUN ARNP
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Gender | Female
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Dates
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Enumeration Date | 06/04/2009
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 4348 SOUTHPOINT BLVD STE 100
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City | JACKSONVILLE
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State | FL
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Zip | 32216-0986
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Country | US
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Telephone | 904-281-1915
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Fax | 904-281-1119
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Provider Business Mailing Address
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Address Line | PO BOX 16568
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City | JACKSONVILLE
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State | FL
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Zip | 32245-6568
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Country | US
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Telephone | 904-472-2300
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Fax | 904-472-2330
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP3285412
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | ARNP 3285412
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | APRN3285412
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License Number State | FL
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