Basic Information
| Provider Information | |||||||||
| NPI: | 1942968524 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEACON HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1656 MEDICAL BLVD STE 301 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341101423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2397321133 | ||||||||
| FaxNumber: | 2397321145 | ||||||||
| Practice Location | |||||||||
| Address1: | 1656 MEDICAL BLVD STE 301 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341101423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395936204 | ||||||||
| FaxNumber: | 2397992131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2021 | ||||||||
| LastUpdateDate: | 06/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | ROSS | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2397321133 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.