Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | ARNP1697012 | FL |
NPI | 1003810672 |
---|---|
Provider Name | Andrea Beale |
First Address | Lakeland, FL 33805-4543 |
Second Address | Lakeland, FL 33803-3818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2005 |
Last Update Date | 29/07/2015 |