Provider Demographics
NPI:1518592427
Name:BILLINGS, BEAU JACOB
Entity Type:Individual
Prefix:
First Name:BEAU
Middle Name:JACOB
Last Name:BILLINGS
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 1:1115 W CALL ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-3556
Mailing Address - Country:US
Mailing Address - Phone:941-740-2328
Mailing Address - Fax:
Practice Address - Street 1:1115 W CALL ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-3556
Practice Address - Country:US
Practice Address - Phone:941-740-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program