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General NPI Number Information
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NPI Number | 1497315121
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Entity Type | Individual
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Provider Name | WILDA B BEAUVAIS DR.
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Gender | Female
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Dates
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Enumeration Date | 06/14/2019
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 6453 PEMBROKE RD
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City | HOLLYWOOD
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State | FL
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Zip | 33023-2137
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Country | US
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Telephone | 954-559-4066
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Fax |
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Provider Business Mailing Address
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Address Line | 6453 PEMBROKE RD FL 33025
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City | HOLLYWOOD
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State | FL
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Zip | 33023-2137
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Country | US
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Telephone | 954-859-6294
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Fax | 954-859-6152
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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 | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | RN9435744
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License Number State | FL
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