MEDICARE: MS. BEVERLY EMELINA BELTRAN FNP

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
1	363LF0000X	Family Nurse Practitioner	RN124223	GA

General Provider Information

NPI Number	:	1639159569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BEVERLY EMELINA BELTRAN FNP

Provider Business Mailing Address
First Line	:	PO BOX 1728
Second Line	:
City	:	WATKINSVILLE
State	:	GA
Zip	:	30677-0034
Country	:	US
Telephone Number	:	678-689-1100
Fax Number	:	678-722-8206

Provider Business Practice Location Address
First Line	:	771 OLD NORCROSS RD
Second Line	:	SUITE 135
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-4386
Country	:	US
Telephone Number	:	678-689-1100
Fax Number	:	678-722-8206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	10/02/2015

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