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NPI Code Detail

MEDICARE: ELYSE D BEAUBRUN ARNP

MEDICARE: ELYSE D BEAUBRUN ARNP
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerARNP3285412FL
2363LX0001XObstetrics & Gynecology Nurse PractitionerARNP 3285412FL
3367A00000XAdvanced Practice MidwifeAPRN3285412FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396971305
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELYSE D BEAUBRUN ARNP
Provider Business Mailing Address
First Line : PO BOX 16568
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32245-6568
Country : US
Telephone Number : 904-472-2300
Fax Number : 904-472-2330
Provider Business Practice Location Address
First Line : 4348 SOUTHPOINT BLVD
Second Line : STE 100
City : JACKSONVILLE
State : FL
Zip : 32216-0986
Country : US
Telephone Number : 904-281-1915
Fax Number : 904-281-1119
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2009
Last Update Date : 10/07/2020

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Directions to “ ELYSE D BEAUBRUN ARNP” Practice Location

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