Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 1759182 | FL |
NPI | 1114129699 |
---|---|
Provider Name | Dr. Michele Jeanne Beaulieu |
First Address | Saint Petersburg, FL 33704-2411 |
Second Address | St Petersburg, FL 33701-4634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 16/08/2016 |