Provider Demographics
NPI:1629611900
Name:IASIMONE, BETH ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:IASIMONE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 731
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32759-0731
Mailing Address - Country:US
Mailing Address - Phone:321-220-3895
Mailing Address - Fax:321-265-4690
Practice Address - Street 1:275 N GAINES ST
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:FL
Practice Address - Zip Code:32759-9537
Practice Address - Country:US
Practice Address - Phone:321-220-3895
Practice Address - Fax:321-265-4690
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-19
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9190670163W00000X, 163WA2000X, 163WH0200X, 163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty