Provider Demographics
NPI:1639504327
Name:VIRGINIA BEATON FNP- FAMILY HEALTH PC
Entity Type:Organization
Organization Name:VIRGINIA BEATON FNP- FAMILY HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPANY OWNER/ NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-499-3223
Mailing Address - Street 1:16 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4024
Mailing Address - Country:US
Mailing Address - Phone:631-499-3223
Mailing Address - Fax:
Practice Address - Street 1:16 PINE RIDGE DR
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4024
Practice Address - Country:US
Practice Address - Phone:631-499-3223
Practice Address - Fax:631-486-4531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334054-1261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care