Provider Demographics
NPI:1346611589
Name:LIBOS, BEATRIZ A (PA-C)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:A
Last Name:LIBOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-382-0700
Mailing Address - Fax:954-382-0400
Practice Address - Street 1:260 SW 84TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2715
Practice Address - Country:US
Practice Address - Phone:954-382-0700
Practice Address - Fax:954-382-0400
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108899363AM0700X
FLPAT9108899363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016913300Medicaid