MEDICARE: BEACH HEALTH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
3	103TC1900X	Counseling Psychologist
4	101YP2500X	Professional Counselor
5	103T00000X	Psychologist
6	103TC0700X	Clinical Psychologist
7	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1215759048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACH HEALTH PLLC

Provider Business Mailing Address
First Line	:	3618 SWANS LANDING DR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-4439
Country	:	US
Telephone Number	:	727-542-4552
Fax Number	:

Provider Business Practice Location Address
First Line	:	3618 SWANS LANDING DR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-4439
Country	:	US
Telephone Number	:	727-542-4552
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	JESSICA BEACKKOFSKY
Credential	:	MD
Telephone Number	:	813-279-8878

Provider Enumeration Date	:	10/31/2024
Last Update Date	:	04/06/2025

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Directions to “BEACH HEALTH PLLC ” Practice Location

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