Provider Demographics
NPI:1013409192
Name:BEAUPLAN, KERLANDE
Entity Type:Individual
Prefix:
First Name:KERLANDE
Middle Name:
Last Name:BEAUPLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13873 AZALEA CIR APT 202
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3818
Mailing Address - Country:US
Mailing Address - Phone:239-738-2889
Mailing Address - Fax:
Practice Address - Street 1:13873 AZALEA CIR APT 202
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3818
Practice Address - Country:US
Practice Address - Phone:239-738-2889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL18000046900332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies