Provider Demographics
NPI:1629626429
Name:BEALS, PATRICIA C
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:C
Last Name:BEALS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2752 ANNHURST AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-3478
Mailing Address - Country:US
Mailing Address - Phone:407-719-9849
Mailing Address - Fax:
Practice Address - Street 1:2752 ANNHURST AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-3478
Practice Address - Country:US
Practice Address - Phone:321-400-5919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider