MEDICARE: BEACH HEALTH CENTER LLC

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	363A00000X	Physician Assistant	PA 9104861	FL

General Provider Information

NPI Number	:	1720388754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACH HEALTH CENTER LLC

Provider Business Mailing Address
First Line	:	6051 ESTERO BLVD
Second Line	:
City	:	FORT MYERS BEACH
State	:	FL
Zip	:	33931-4348
Country	:	US
Telephone Number	:	239-765-6000
Fax Number	:	239-765-6008

Provider Business Practice Location Address
First Line	:	16517 VANDERBILT DR STE 3
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-7550
Country	:	US
Telephone Number	:	239-765-6000
Fax Number	:	239-765-6008

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MS. ELIZABETH ULMAN
Credential	:	PA-C
Telephone Number	:	239-765-6000

Provider Enumeration Date	:	10/25/2010
Last Update Date	:	09/19/2025

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