Provider Demographics
NPI:1447800495
Name:BEAUGE, JONAS
Entity Type:Individual
Prefix:
First Name:JONAS
Middle Name:
Last Name:BEAUGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 SE WALTON LAKES DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5107
Mailing Address - Country:US
Mailing Address - Phone:954-260-6483
Mailing Address - Fax:
Practice Address - Street 1:1607 SE WALTON LAKES DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5107
Practice Address - Country:US
Practice Address - Phone:954-260-6483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL236167374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide