Provider Demographics
NPI:1477899458
Name:CARUTHERS, BEAU JASON (ARNP)
Entity Type:Individual
Prefix:
First Name:BEAU
Middle Name:JASON
Last Name:CARUTHERS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 SE 18TH ST
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5408
Mailing Address - Country:US
Mailing Address - Phone:352-622-1126
Mailing Address - Fax:352-622-2391
Practice Address - Street 1:1740 SE 18TH ST
Practice Address - Street 2:SUITE 1002
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5408
Practice Address - Country:US
Practice Address - Phone:352-622-1126
Practice Address - Fax:352-622-2391
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9255567363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner